Allergic rhinitis due to pollen
J30.1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
This is the American ICD-10-CM version of J30.1. Other international versions of ICD-10 J30.1 may differ.
Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.
Clinical Information
Allergic rhinitis caused by outdoor allergens.
Allergic rhinitis that occurs at the same time every year. It is characterized by acute conjunctivitis with lacrimation and itching, and regarded as an allergic condition triggered by specific allergens.
Each spring, summer, and fall, trees, weeds and grasses release tiny pollen grains into the air. Some of the pollen ends up in your nose and throat. This can trigger a type of allergy called hay fever.symptoms can include
sneezing, often with a runny or clogged nose
coughing and postnasal drip
itching eyes, nose and throat
dark circles under the eyes
taking medicines, using nasal sprays and rinsing out your nose can relieve symptoms.
Allergy shots can help make you less sensitive to pollen and provide long-term relief. Seasonal variety of allergic rhinitis, marked by acute conjunctivitis with lacrimation and itching; regarded as an allergic condition triggered by specific allergens.
Applicable To
Allergy NOS due to pollen
Hay fever
Pollinosis
Approximate Synonyms
Allergic rhinitis (nose congestion), pollen
The following ICD-10-CM Index entries contain back-references to ICD-10-CM J30.1:
Allergy, allergic (reaction) (to) T78.40
due to pollen J30.1
grain J30.1
grass (hay fever) (pollen) J30.1
nasal, seasonal due to pollen J30.1
pollen (any) (hay fever) J30.1
primrose J30.1
primula J30.1
ragweed (hay fever) (pollen) J30.1
rose (pollen) J30.1
Senecio jacobae (pollen) J30.1
tree (any) (hay fever) (pollen) J30.1
inhalant (rhinitis) J30.89
pollen J30.1
CPT/HCPCS Codes
# Not covered for Priority Health Medicaid Testing: (Laboratory tests are subject to laboratory benefits)
82785 Gammaglobulin; IgE
86001 Allergen specific IgG quantitative or semiquantitative, each allergen
86003 Allergen specific IgE; quantitative or semiquantitative, each allergen
86005 Allergen specific IgE; qualitative, multiallergen screen (dipstick, paddle or disk)
86021 Antibody identification; leukocyte antibodies
95004 Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests.
95012 Nitric oxide expired gas determination
95017 Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with venoms, immediate type reaction, including test interpretation and report, specify number of tests
95018 Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with drugs or biologicals, immediate type reaction, including test interpretation and report, specify number of tests
95024 Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests.
ICD-10 Codes that may support medical necessity:
D69.0 Allergic purpura
H10.401 – H10.409 Unspecified chronic conjunctivitis
H10.421 – H10.429 Simple chronic conjunctivitis
H10.44 Vernal conjunctivitis
H16.261 – H16.269 Vernal keratoconjunctivitis, with limbar and corneal involvement
H10.411 – H10.419 Chronic giant papillary conjunctivitis
H10.45 Other chronic allergic conjunctivitis
H10.9 Unspecified conjunctivitis
J30.0 – J30.9 Vasomotor and allergic rhinitis
J31.0 – J31.2 Chronic rhinitis, nasopharyngitis and pharyngitis
J32.0 – J32.9 Chronic sinusitis
J33.0 – J33.9 Nasal polyp
J45.20 – J45.998 Asthma
K52.21-K52.29 Allergic and dietetic gastroenteritis and colitis
K52.89 Other specified noninfective gastroenteritis and colitis
K52.9 Noninfective gastroenteritis and colitis, unspecified
L20.0 – L20.9 Atopic dermatitis
L22 Diaper dermatitis
L23.0 – L23.9 Allergic contact dermatitis
L24.0 – L24.9 Irritant contact dermatitis
L25.0 – L25.9 Unspecified contact dermatitis
L27.0 – L27.9 Dermatitis due to substances taken internally
L29.8 Other pruritus
L29.9 Pruritus, unspecified
L30.0 – L30.9 Other and unspecified dermatitis
L50.0 Allergic urticaria
L50.1 Idiopathic urticaria
L50.6 Contact urticaria
L50.8 Other urticaria
L50.9 Urticaria, unspecified
L56.4 Polymorphous light eruption
T50.905A-T50.905S Adverse effect of unspecified drugs, medicaments and biological substances
T50.995A-T50.905S Adverse effect of other drugs, medicaments and biological substances
T78.00xA-T78.1xxS Anaphylactic reaction due to food
T78.40xA-T78.49xS Other and unspecified allergy
Z01.82 Encounter for allergy testing
Z91.010 – Z91.09 Allergy status, other than to drugs and biological substances
Z88.0 Allergy status to penicillin
Z88.1 Allergy status to other antibiotic agents statusZ88.2 Allergy status to sulfonamides status
Z88.3 Allergy status to other anti-infective agents status
Z88.4 Allergy status to anesthetic agent status
Z88.5 Allergy status to narcotic agent status
Z88.6 Allergy status to analgesic agent status
Z88.7 Allergy status to serum and vaccine status
Z88.8 Allergy status to other drugs, medicaments and biological substances status
Z88.9 Allergy status to unspecified drugs, medicaments and biological substances status
Z91.010 Allergy to peanuts
Z91.011 Allergy to milk products
Z91.012 Allergy to eggs
Z91.013 Allergy to seafood
Z91.018 Allergy to other foods
Allergy Sensitivity Testing:
These tests include the performance and evaluation of selective cutaneous and mucous membrane tests in correlation with history, physician examination, and other observations of the patient. The tests are performed to determine body sensitivity and reaction to the antigen for the purpose of diagnosing the presence of allergic reaction to antigenic stimuli. The number of tests performed should be judicious and dependent upon the history, physical findings and clinical judgment. All patients should not necessarily receive the same tests or the same number of sensitivity tests. Rather testing should be patient specific based on the history and physical examination.
These tests are injection of small amounts of antigen into the superficial layers of the skin. This is the preferred method for allergy testing. Medicare considers percutaneous (scratch, prick or puncture) testing medically reasonable and necessary when IgE-Medicated reactions occur to any of the following:
• Inhalants
• Foods
• Hymenoptera (stinging insects)
• Specific drugs (such as penicillin or macromolecular agents)
Allergy Testing
In order for allergy testing to be considered reasonable and necessary by Medicare, antigens must meet all the following criteria;• Skin testing must be performed based on history and physical exam,
• Proven efficacy as demonstrated through scientifically valid medical studies published in peer-review journal, and
• Exist in the patient’s environment with a reasonable probability of exposure
Patch testing is the gold standard method of identifying the cause of allergic contact dermatitis. This testing is indicated to evaluate a nonspecific dermatitis, allergic contact dermatitis, pruritus, and other dermatitis to determine the causative antigen. It is a diagnostic test reserved for patients with skin eruptions for which a contact allergy source is likely.
Allergy patch testing is a covered procedure only when used to diagnose allergic contact dermatitis after the following exposures: dermatitis due to detergents, oils and greases, solvents, drugs and medicines in contact with skin, other chemical products, food in contact with skin, plants (except food), cosmetics, metals, other and unspecified.
Challenge ingestion food testing is a safe and effective technique in the diagnosis of food allergies. This procedure, when considered reasonable and necessary for the individual patient, is covered on an outpatient basis. Please refer to CMS Pub. 100-03, Medicare National Coverage Determination Manual, Chapter 1, Part 2 Section 110.12.
Medicare will consider challenge ingestion food testing reasonable and necessary for the following indications:
• Food allergy dermatitis
• Anaphylactic shock due to adverse food reaction
• Allergy to medicinal agents
• Allergy to foods
Challenge ingestion food testing has not been proven to be effective in the diagnosis of rheumatoid arthritis, depression, or respiratory disorders. Accordingly, its use in the diagnosis of these conditions is not reasonable and necessary within the meaning of Section 1862 (a)(1) of Medicare law. Therefore, this service is considered non-covered.
The number of tests done, choices of antigens, frequency of repetition and other coverage issues are the same as for skin testing. Control testing is essential for proper interpretation. It is rarely necessary to test for more than 50 allergens and, if food allergy is not suspected, fewer than 30 are usually sufficient. Testing must be based on a careful history/physical examination which suggests IgE- mediated disease. If testing is inconclusive, and contraindications have been resolved, then skin testing may be done and is considered reasonable and necessary. The medical records must document this rationale.
• Direct skin testing is not possible due to extensive dermatitis, dermographism, ichthyosis, generalized eczema or the necessary continued use of H-1 blockers (antihistamines), or in the rare patient with a persistent unexplained negative histamine control;
• Testing in patients who have been receiving long acting antihistamines, tricyclic antidepressants, betablockers or medication that may put the patient at undue risk if they are discontinued;
• Testing of uncooperative patients with mental or physical impairments;
• The evaluation of cross-reactivity between insect venoms;
• As adjunctive laboratory tests for disease activity of allergic bronchopulmonary aspergillosis and certain parasitic diseases; and
• When clinical history suggests an unusually greater risk of anaphylaxis from skin testing than usual (e.g., when an unusual allergen is not available as a licensed skin test extract).
• Total serum IgE: Measurements of total IgE levels (CPT code 82785-gammaglobulin {immunoglobulin}; IgE) are not appropriate in most general allergy testing which is performed to determine a patient’s immunologic sensitivity or reaction to particular allergens for the purpose of identifying the cause of the allergic state. It would not be expected that total serum IgE levels would be billed unless evidence exists for the following:
1. follow-up of bronchopulmonary aspergillosis,
2. to diagnose atopy in small children,
3. select immunodeficiency, such as the syndrome of hyper-IgE,
4. eczematous dermatitis,
5. recurrent pyogenic infections, or
6. in the evaluation of omalizumab therapy.
• Serial, repeat testing of total IgE will be subject to medical review. It is not appropriate in most general allergy testing. Instead, individual IgE tests are performed against a specific antigen.
Allergen-specific IgG and IgG subclasses measured by using immunoabsorption assays and IgG and IgG subclass antibody tests for food allergy/delayed food allergy /delayed food allergic symptoms or intolerance to specific foods (e.g. CPT code 86001) are considered experimental and investigational, as there is insufficient evidence in the published peer-reviewed scientific literature to support the diagnostic value of these tests for allergy testing.
