Referral Guidance
When Is a Referral Required?
Some insurance plans require a referral before visits can be covered. A referral is commonly required if you have an HMO or managed-care plan and if your plan requires a Primary Care Provider to authorize specialty care. Other plans, like PPO, EPO, and Medicare, among others, typically do not require referrals, but rules vary by plan.
ALWAYS confirm with your insurance company by calling the number on the back of your card.
Ensure that you are aware of the total number of visits allowed or if coverage is for a set time period. Once the visits are used or the referral expires, a new referral is required.
If your insurance requires a referral and one is not on file, your visit may not be covered and you may be responsible for the charges.
For referring providers, please include the diagnosis, number of visits, and authorization dates when submitting referrals.
Referral Guide - Mast Cell Disorders
Our Approach
We are committed to thoughtful, evidence-based care and to partnering with patients and referring clinicians to ensure appropriate evaluation and management. Our goal is to identify patients most likely to benefit from specialized allergy and immunology care, while avoiding unnecessary testing or misdiagnosis.
When referral requests fall outside the scope of evidence-based mast cell evaluation or the services we provide, we may recommend alternative pathways or redirect care to ensure patients are best supported by the most appropriate specialty. We approach these decisions with respect, transparency, and a focus on aligning patients with care that is most likely to be helpful.
At our practice, we evaluate patients for Mast Cell Activation Syndrome (MCAS) using established, evidence-based diagnostic criteria. MCAS is a condition defined by episodic mast cell mediator release, rather than chronic, nonspecific symptoms. As awareness of MCAS has grown, we aim to provide clarity about when evaluation is most appropriate and likely to be helpful.
When MCAS Evaluation Is Appropriate
MCAS is not diagnosed based on symptoms alone. Chronic symptoms such as hypermobility or Ehlers-Danlos syndrome, fatigue, brain fog, neuropathic pain, vertigo, dysautonomia, or chronic abdominal pain—when occurring without clear episodic flares—do not meet diagnostic criteria and are unlikely to represent MCAS on their own.
We also do not evaluate or test for chemical sensitivities, mold toxicity, long-COVID–related concerns, or chronic multisystem illness that is not clearly linked to mast cell activation.
Evaluation for MCAS is most appropriate for patients who experience recurrent, acute episodes consistent with mast cell activation.
Symptoms That Support MCAS Evaluation
Symptoms typically occur in flares and may involve multiple organ systems, such as:
Skin: flushing, hives, angioedema, itching without a primary rash
Gastrointestinal: acute cramping, diarrhea, nausea, or vomiting during episodes
Cardiovascular: lightheadedness, presyncope, syncope, hypotension, or episodic tachycardia
Respiratory: wheezing, throat tightness, episodic nasal congestion
Systemic: anaphylaxis or near-anaphylaxis without an identifiable trigger
Diagnostic Criteria We Use
A key component of MCAS evaluation is objective evidence of mast cell mediator release, which may include:
Elevated serum tryptase collected during an acute episode and compared with baseline
Elevated urinary mast cell mediators collected during or shortly after symptomatic episodes
A clear, reproducible clinical response to mast cell–directed therapy (such as H1/H2 antihistamines, leukotriene modifiers, or mast cell stabilizers)
When MCAS Is Less Likely
Isolated chronic symptoms without discrete flares
Symptoms limited to a single organ system
No objective laboratory evidence of mast cell activation
No meaningful response to mast cell-targeted treatment
In these situations, we recommend pursuing alternative diagnoses prior to referral or formal MCAS evaluation.