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Does Medicare Cover Allergy Testing?

Allergic conditions are one of the most common health issues in the U.S., so it’s a good thing Medicare can cover most allergy testing.

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More than 50 million people in the U.S. have allergies every year, and allergies are the sixth leading cause of chronic illness in our country.

When you have an allergic reaction to something, your immune system is reacting to a foreign substance, or allergen. Common allergies include:

  • Indoor/outdoor allergies to allergens like pollen, dust mites, insect stings or pet dander

  • Seasonal allergies, or rhinitis (hay fever), that typically occur in the spring or fall

  • Skin allergies to things like poison ivy, certain foods or latex

  • Food allergies to things like peanuts, milk, soy or shellfish

  • Drug allergies to drugs like penicillin

Allergic reactions can range from mild to severe or even life-threatening. If you’re allergic to something, it may cause you to cough, sneeze, have hives or rashes, a scratchy throat, or it could trigger anaphylaxis — an extreme immune reaction that can cause your body to go into shock.

Because allergies are so widespread, Medicare does cover allergy testing ordered by a doctor or other qualified health provider. If your doctor considers an allergy test to be medically reasonable and necessary for diagnosis or treatment, Medicare may cover this.

What Criteria Do I Have To Meet for Allergy Test Coverage?

If you have Medicare Part B, you could be covered as part of the “clinical diagnostic laboratory services” category. Medicare Part B allergy test coverage depends on the following criteria:

  • It must be prescribed by a physician who is enrolled in Medicare and accepts Medicare assignment.

  • The allergy test must be medically necessary according to documentation from your doctor that proves it is.

  • The allergy test has to be done in a Medicare-approved facility.

  • Your allergy symptoms have not been alleviated by other treatments you’ve tried.

  • Your doctor can prove the allergy test is the start of a complete, Medicare-approved treatment program.

Not all allergy tests can be covered by Medicare, so please check with your individual physician and Medicare plan to be sure.

What Allergy Testing Does Medicare Cover?

When it comes to allergy testing, there are two broad categories: in vitro, or blood serum analysis, and in vivo, or skin tests.

In vitro testing can be covered by Medicare when skin testing isn’t possible or could be unreliable. However, it’s typically not covered when it’s done in addition to a skin test for the same antigen.

In vivo testing can involve a number of different methods, including:

These Medicare-covered allergy tests may help your doctor develop an allergy treatment plan that includes allergen avoidance, medications or allergy shots (immunotherapy). Speak with your doctor about allergy testing to see what your Medicare plan may cover.

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LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.