Does Medicare Cover Allergy Testing? | Medicare Health Plans

Does Medicare Cover Allergy Testing?

Allergies (whether seasonal, environmental, or food related) will likely affect most of us at some point in our lives. More than 50 million Americans suffer from allergies, according to the Centers for Disease Control and Prevention (CDC). While there is no cure for allergies, your doctor may recommend and prescribe allergy tests and/or allergy shots to treat your condition.

When Are Allergy Tests Covered by Medicare?

Medicare covers allergy skin tests when you have a documented history of allergic reactions and show significant allergic symptoms not controlled by other therapy.

Medicare covers allergy tests when:

  • You are in an environment with a reasonable probability of exposure to the substance in question.
  • The test correlates with your history and physical findings.
  • The test technique used for allergen detection provides accurate results in scientifically valid medical studies published in peer-reviewed literature.

Medicare covers allergy shots when:

  • A doctor has prescribed the shots.
  • The prescribing doctor deems the allergy shots medically necessary for your condition.

The type of allergy you have will also determine whether Medicare will cover the allergy shots.

Medicare may cover tests that result in immunoglobulin E (IgE) mediated allergic reactions. These reactions are a result of the production of IgE antibodies when your body comes into contact with certain allergens.

Types of Allergy Tests

There are two, general categories of allergy tests:

  • Skin allergy tests
  • Blood allergy tests

Skin allergy tests require contact between the suspected allergen and your skin to see if an allergic reaction occurs. Allergy blood tests measure the number of certain antibodies in your system released when you come into contact with an allergen.

When it comes to testing for food allergies, a food challenge test provides the best results, according to The Children’s Hospital of Philadelphia. These food challenge tests involve eating small, increasing amounts of the suspected food allergen in a hospital setting. As you eat the food, you will be closely watched for a reaction.

What Allergy Tests Does Medicare Cover?

Medicare only covers specific types of allergy tests, and only when the tests have proven to provide effective and accurate results for certain types of allergens.

Skin tests that involve scratching, pricking or puncturing are the most common types of skin tests. Medicare covers these tests when IgE-mediated reactions occur to the following types of suspected allergens:

  • Food
  • Inhalants
  • Insects that sting
  • Specific types of drugs, like penicillins

Intradermal, or intracutaneous testings, are tests that involve injecting a small amount of the allergen into your skin. Medicare covers these when the following types of suspected allergens cause IgE-mediated reactions occur:

  • Inhalants
  • Insects that sting
  • Specific types of drugs

Medicare can also cover testing for food allergies used on an outpatient basis and deemed reasonable and necessary for the patient, according to the Medicare National Coverage Determinations Manual.

As always, Medicare coverage eligibility comes down to how necessary and reasonable the treatment is for you, as well as your particular Medicare plan. You should speak with a medical professional to determine if Medicare covers your particular allergy testing and/or allergy shots.

Still have Medicare questions? Talk to a licensed agent at 855-802-1206.

Which Specific Allergy Tests Are Covered by Medicare?

Now that you know the basics of allergy test coverage, let’s dig deeper. Medicare makes things even more complicated when it comes to allergy testing by only covering specific types of tests. These tests have been proven to provide effective and accurate results for certain types of allergens.

Skin tests that involve scratching, pricking or puncturing are the most common types of skin tests. They are technically called percutaneous tests. These tests can be covered by Medicare when IgE-mediated reactions occur to the following types of suspected allergens, according to the AMA:

  • Food
  • Inhalants
  • Insects that sting
  • Specific types of drugs, like penicillins

Sometimes, further testing will be needed if the scratch, prick or puncture tests show up negative. Tests that involve injecting a small amount of the allergen into your skin may be necessary, based on your clinician’s findings. This type of test is technically called intradermal, or intracutaneous, testing. These tests may be covered when the following types of suspected allergens cause IgE-mediated reactions occur, according to the AMA:

  • Inhalants
  • Insects that sting
  • Specific types of drugs

Challenge food testing can also be covered by Medicare for food allergy testing, as long as it is used on an outpatient basis and is deemed reasonable and necessary for the patient, according to the Medicare National Coverage Determinations Manual.

As always, Medicare coverage eligibility comes down to how necessary and reasonable the treatment is for you. You should peak with a medical professional to determine if your particular allergy testing can be covered by Medicare. Make sure to like us on Facebook to stay updated with the latest Medicare coverage news!

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