This bulletin article applies to NC Medicaid Direct.
Effective Feb. 1, 2025, the CPT codes in the table below will have new unit limitations. Clinical coverage policies 1N1 Allergy Testing and 1N2 Allergy Immunotherapy are in the process of being updated to reflect this guidance. A bulletin will be published announcing the final posting of these policies.
Existing coverage will not be revoked; rather, both policies will be updated to reflect current practice standards. Please consult the relevant clinical coverage policy upon its final posting for detailed information regarding this update.
CPT Code | Previous Unit Limitations | New Unit Limitations |
|---|---|---|
| 1N1 Allergy Testing | ||
| 86003 | 36 units per year | 30 units per 365 calendar days |
| 86005 | n/a | 2 units per day up to 30 allergens per 365 calendar days |
| 95004 | 75 units per year | 80 units per 365 calendar days |
| 95017 | 30 units per date of service | 27 units per date of service |
| 95024 | 20 units per year | 30 units per 365 calendar days |
| 95027 | 20 units per year | 20 units per 365 calendar days |
| 95028 | 20 units per year | 20 units per 365 calendar days |
| 95044 | 36 units per year | 80 units per 365 calendar days |
| 95052 | n/a | 36 units per date of service |
| 95056 | n/a | 1 unit per date of service |
| 95071 | removed due to obsoletion | removed due to obsoletion |
| 1N2 – Allergy Immunotherapy | ||
| 95180 | 12 units per date of service | 6 units per date of service |
| 95145 | 1 unit per date of service | 10 units per date of service |
| 95146 | 1 unit per date of service | 10 units per date of service |
| 95147 | 1 unit per date of service | 10 units per date of service |
| 95148 | 1 unit per date of service | 10 units per date of service |
| 95149 | 1 unit per date of service | 10 units per date of service |
| 95170 | 1 unit per date of service | 10 units per date of service |
The following 10 codes will remain unchanged:
- 1N1 Allergy Testing -95018, 95027, 95028, 95070, 95076, 95079
- 1N2 Allergy Immunotherapy - 95115, 95117, 95144, 95165
Contact
NCTracks Call Center: 800-688-6696