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April 2024
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LCD for Allergy Immunotherapy (L36408)
See related Articles:
A54841-Response to Comments: Allergy Immunotherapy (L36408)
A57472-Billing and Coding: Allergy Immunotherapy

Contractor Information

Contractor Name: Wisconsin Physicians Service Insurance Corporation - Full list of policies of this Medicare Contractor

Contractor Number: 05401

Contractor Type: MAC A

LCD Information

LCD ID Number: L36408 Status: A-Approved

LCD Title: Allergy Immunotherapy

Geographic Jurisdiction: Nebraska Other Jurisdictions

Original Determination Effective Date: 03/18/2016

Original Determination Ending Date:

Revision Effective Date: 10/26/2023

Revision End Date:

CMS National Coverage Policy:

Italicized font – represents CMS national NCD language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national NCD language/wording.

Title XVIII of the Social Security Act, Section 1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Title XVIII of the Social Security Act, Section 1862 (a) (1) (A) allows coverage and payment of those items or services that are considered to be medically reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, Section 1862 (a) (1) (D) excludes investigational or experimental from Medicare coverage.

42 CFR Section 410.68 – Antigens: Scope and Conditions. This section describes that Medicare Part B pays for (a) antigens that are furnished as services incident to a physician’s professional services; or (b) a supply of antigen sufficient for not more than 12 months that is. It describes who prepares, administers, and supervises.

CMS Pub 100-02 Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services, Sections
20.2 – Physician Expense for Allergy Treatment, – Antigens,
60.2 – Services of Nonphysician Personnel Furnished Incident to Physician’s Services
80.1 – Clinical Laboratory Services, and
80.6 – Requirements for Ordering and Following Orders for Diagnostic Tests.
Chapter 16 – General Exclusions From Coverage, Section
90 – Routine Services and Appliances, B. Antigens.

CMS Pub 100-03 Medicare National Coverage Determinations (NCD) Manual, Chapter 1 – Coverage Determinations, Part 2, Sections
110.9 – Antigens Prepared for Sublingual Administration
110.11 – Food Allergy Testing and Treatment

CMS Pub 100-04 Medicare Claims Processing Manual, Chapter 12 – Physicians/Nonphysician Practitioners, Section
200 - Allergy Testing and Immunotherapy, and
Chapter 16 – Laboratory Services, Section
40.7 – Billing for Noncovered Clinical Laboratory Tests.

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04/17/2024 10:25:24

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