Does Medicare cover your allergy testing costs? That’s a good question, and the answer is sometimes “yes”; however, that yes depends on a number of factors. Allergy testing is usually covered when clinically significant allergic history or symptoms that are not manageable by therapy continue to persist. This means that your doctor must prescribe allergy testing after exhausting other possible alternatives. Your doctor must of course be enrolled in Medicare, otherwise Medicare will not cover any prescribed testing costs.
The Different Types of Allergy Tests
Medicare typically covers procedures known as percutaneous allergy testing. Percutaneous testing involves puncturing, pricking, or scratching the skin and applying an allergen to test for a reaction. Tests usually involve checking for reactions to:
- hymenoptera (insect bites or stings)
- drugs such as penicillin
- macromolecular agents
If intradermal testing — injecting allergens under the skin — is necessary, Medicare will sometimes cover these procedures for the reactants listed above (except food).
For food allergies, Medicare might also cover challenge food testing. This is where a small amount of a food is introduced to the diet in increasing amounts. While this is often done in a hospital setting, Medicare may cover it if done on an outpatient basis. It must also be deemed reasonable and medically necessary for the patient.
Patch testing, a method of identifying skin contact allergies, is sometimes covered by Medicare in very specific cases. These cases include contact due to:
- oils or greases
- drugs and medicines
- various chemical products
While Medicare does cover a fairly wide range of allergy testing procedures as outlined above, the federal government’s health care program declines coverage in just as many instances. For example, Medicare will generally not cover food allergy testing for patients who have respiratory symptoms other than asthma or wheezing. Medicare also does not cover skin endpoint testing, nor does it cover neutralization testing. it doesn’t cover therapy for subcutaneous, intracutaneous, or sublingual food allergies. Furthermore, Medicare declines coverage for allergy testing related to antigens for which no clinical evidence is presented in peer-reviewed scientific literature. Antigens include tobacco smoke, grain mill dust or pollens from cereals and related crops, orris root, marigold, dandelion, and honeysuckle.
Who Pays for Allergy Tests?
Testing for some antigens is covered by Medicare only when patients and their doctors can demonstrate that the patient’s environment provides exposure said antigens. These antigens include tobacco leaf (for tobacco workers), pyrethrum and goldenrod (for florists), soybean dust (for food processing workers), and wool for those patients exposed to unprocessed wool or sheep.
In all cases of possible Medicare coverage, the patient’s doctor must provide documentation illustrating that allergy testing is medically necessary. The doctor must also show that the testing is part of a treatment program that is safe, effective, and of a duration and a frequency that Medicare considers appropriate. Consult with your doctor prior to receiving testing or treatment to be sure that the services rendered will be covered by Medicare. Allergy services typically fall under Medicare Plan B or Medicare Plan D. You may also contact Medicare by phone at 1-800-633-4227 for more information.