Allergies happen to almost everyone it seems nowadays. Whether it’s seasonal, environmental, food or just a random occurrence, at some point, you may need allergy tests, shots or medication to help with your condition.
Does Medicare cover allergy testing?
Allergy tests are considered part of the “clinical diagnostic laboratory services” category for Medicare. If you meet the below criteria, Medicare Part B coverage may apply.
Medicare Part B may cover allergy testing if you meet all the below criteria:
- Your physician must prescribe the allergy test
- Your physician must be enrolled in Medicare and accept assignment
- The test must be considered medically necessary, and your physician must provide documentation that says so
- The testing must take place in a Medicare-approved laboratory
- No previous therapy alternatives have been able to manage your allergies or allergy symptoms
- Your physician can prove this testing is the first part of a complete, Medicare-approved treatment program
Not all allergy testing procedures will be covered or paid for by Medicare. You should always check with your health care provider and Medicare plan provider to understand which tests are covered and how. Some tests may be covered by a Medicare Advantage that Medicare Part B doesn’t cover, but you will need to ask your plan provider directly.
What allergy tests does Medicare cover?
While Medicare Part B may provide coverage for allergy tests that are considered clinical diagnostic laboratory tests, a Medicare Advantage plan may also cover additional or different tests. Again, you’ll need to ask your plan provider about what other tests or allergy services may be provided and how coverage works.
In general, the following allergy tests may be covered by Medicare Part B:
- Skin (Percutaneous) Procedures – these test for allergies related to substances such as pollen or animal dander, food, insects, certain drugs and more.
- Blood testing procedures – these test your blood for allergens when your body comes into contact with them by analyzing the presence of antibodies
- Food challenge testing – this test is only covered when done on an outpatient basis to look for allergic reactions to certain foods
You should speak with your primary care physician about allergy testing if you are experiencing any of the following symptoms.
- Itchy, watery or red eyes
- Wheezing, coughing, shortness of breath
- Sneezing with an itchy, runny nose or blocked nasal passages
- Skin that is dry, cracked, red and irritated
- Hives that are red, itchy and persistently appear
- Swelling of the lips, tongue, face or eyes
Medicare coverage for allergy treatments
Many people are able to successfully manage their allergy symptoms and live an active and healthy life. Depending on your allergies, medications may help. Medicare Part D (or a Medicare Advantage plan with included drug coverage) may help with covering some of your allergy prescriptions. You’ll need to check with your plan provider to understand if your allergy medication is covered or not.
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