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LCD ID Number: L36241 Status: A-Approved
LCD Title: Allergy Testing
Geographic Jurisdiction: Louisiana Other Jurisdictions
Original Determination Effective Date:
10/01/2015
Original Determination Ending Date:
Revision Effective Date:
07/01/2020
Revision End Date:
CMS National Coverage Policy:
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for allergy testing services. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for allergy testing services and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site.
IOM Citations:
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual,
- Chapter 15, Section 20.2 Physician Expense for Allergy Treatment, Section 50.4.4.1 Payment for Antigens, Section 60.1 Direct Personal Supervision, and Section 60.2 Services of Nonphysician Personnel Furnished Incident To Physician's Services
- CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual,
- Chapter 1, Part 2, Section 110.9 Antigens Prepared for Sublingual Administration, Section 110.11 Food Allergy Testing and Treatment
- CMS IOM Publication 100-04, Medicare Claims Processing Manual,
- Chapter 12, Section 200 Allergy Testing and Immunotherapy
- CMS IOM Publication 100-08, Medicare Program Integrity Manual,
- Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCD
Social Security Act (Title XVIII) Standard References:
- Title XVIII of the Social Security Act, Section 1862 (a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body.
- Title XVIII of the Social Security Act, Section 1862 (a)(7). This section excludes routine physical examinations.
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04/12/2021 01:42:11 18.206.177.17
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