CAM 20115

Intravenous or Subcutaneous Histamine Therapy

Category:Prescription Drug   Last Reviewed:March 2020
Department(s):Medical Affairs   Next Review:March 2999
Original Date:March 1996    

Description:
The intravenous or subcutaneous administration of histamine is proposed as a treatment for headaches, particularly cluster headaches, sudden hearing loss and Ménière’s syndrome.

Policy:
Intravenous histamine therapy is considered INVESTIGATIONAL for all conditions.

Rationale:
Interest in the therapeutic use of histamine was prompted by the 1937 observation that infusions of intravenous histamine provoked the onset of headaches. This led to the use of chronic intravenous or subcutaneous histamine as a type of desensitization therapy. However, no controlled clinical trials have isolated and validated the efficacy of histamine desensitization, and, in general, this therapy has become discredited over time. (1, 2)

No articles describing the clinical effects of histamine therapy in sudden hearing loss or Ménière’s disease were identified.

References:

  1. Campbell JK. The current status of histamine desensitization in the treatment of cluster headache. In: Mathew NT (ed.). Cluster Headache. Jamaica NY: Spectrum Publishers, 1984.
  2. Sjaastad O. Cluster Headache Syndrome. Philadelphia, PA: WB Saunders, 1992
  3. Jackson CM. Effective headache management. Strategies to help patients gain control over pain. Postgrad Med. 1998;104(5):133-147.
  4. Biondi D, Mendes P. Treatment of primary headache: Cluster headache. In: Standards of Care for Headache Diagnosis and Treatment. Chicago, IL: National Headache Foundation; 2004.

Coding Section

Codes Number Description
CPT 96372

Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug

ICD-9 Procedure 99.29 Injection or infusion of other therapeutic or prophylactic substance
ICD-9 Diagnosis   Investigational for all codes
HCPCS No Code  
Type of Service Medical  
Place of Service Outpatient, Inpatient, Home.  

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology© American Medical Association.  All Rights Reserved" 

History From 2014 Forward     

03/02/2020 

Annual review. No change to policy intent. 

03/01/2019 

Annual review. No change to policy intent. 

03/19/2018 

Annual review. No change to policy intent. 

03/02/2017 

Annual review. No change to policy intent. 

03/01/2016 

Annual review.  No changes made. 

11/05/2015 

Change Category from Medicine to Prescription Drug 

03/10/2015 

Annual review. No change to policy intent. Added coding. 

03/3/2014

Annual review.  No changes made.


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