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Does Medicare Cover Allergy Testing?

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If you’re on Medicare and you’re allergic to foods, pollen, animals, or another natural substance, you might be wondering if allergy testing is covered. The good news is that it is, but it must be ordered by your doctor.

In this MedicareWire article, we will look at how Medicare covers allergy testing and some signs that might indicate you need to be tested.

Key Takeaways

  • Allergies are caused by your body’s immune system overreacting to an otherwise harmless substance.
  • The severity of an allergy can vary. Someone may only get a scratchy throat from eating peanuts while another person goes into anaphylactic shock
  • Allergies can develop later in life, causing unpleasant reactions to substances that did nothing to you before.
  • Medicare will cover allergy testing when ordered by a doctor as a medically necessary diagnostic service.
  • Medicare Advantage members may be limited to what facilities and providers they can get an allergy test from.
  • The most common types of allergy tests covered by Medicare are skin tests and blood tests.

What Are Allergies?

Allergies are when your body’s immune system reacts aggressively to a benign outside substance, such as pollen, animal dander, penicillin, or certain foods. Your immune system produces antibodies, which in turn produce histamines that cause the symptoms of your allergic reaction. Allergies can be as mild as a slight tingling at the point of contact to as severe as going into anaphylactic shock, which requires an immediate shot of epinephrine and emergency medical help.1Mayoclinic.org, “Allergies: Symptoms and causes“, Accessed November 23, 2021

Can I Develop An Allergy Later In Life?

It is possible for you to develop an allergy to a harmless substance that did not produce an immune reaction before, such as seasonal pollen2Newsnetwork.mayoclinic.org, “Mayo Clinic Q and A: Reasons for developing allergies later in life not always clear“, Accessed November 23, 2021. Speak with your primary care doctor about allergy testing if you are experiencing any of the following symptoms:1Mayoclinic.org, “Allergies: Symptoms and causes“, Accessed November 23, 2021

  • 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

How Does Medicare Cover Allergy Testing?

Allergy tests are covered under the clinical diagnostic laboratory services of Medicare Part B. These lab services are covered in full, with no out-of-pocket costs.

In most cases, Medicare Part B or a Medicare Advantage plan will cover allergy testing if you meet the following:3Medicare.gov, “Clinical laboratory tests“, Accessed November 23, 2021

  • Your physician prescribes the allergy test
  • Your physician is enrolled in Medicare and accepts assignment
  • The test is medically necessary, and your physician provides documentation that says so
  • The testing takes place in a Medicare-approved laboratory
  • No previous therapy alternatives have been able to manage your allergies or allergy symptoms
  • Your physician proves the test is the first part of a complete, Medicare-approved treatment program

Not all allergy testing procedures are covered by Medicare. You should always check with your health care provider and Medicare plan provider (if you have a Medicare Advantage plan) to understand which tests are covered.

Allergy Tests Covered by Medicare

Even though Medicare Part B and Medicare Advantage plans cover medically-necessary allergy tests, they do not cover all types of tests. As a general rule, Medicare covers the following types of tests::7CMS.gov, “Allergy Testing“, Accessed November 23, 2021

  1. Blood testing procedures – These tests test your blood for allergens if your body comes in contact with them. They analyze the presence of antibodies.
  2. Food Challenge Testing – This test can only be done when performed on an outpatient basis to check for allergic reactions to certain food items
  3. Percutaneous (Skin) Procedures – These procedures test for allergies to substances like pollen, animal dander, or food.

Medicare-Covered Allergy Medications

If you test positive for an allergy, you may be prescribed allergy medication depending on the nature of the allergy and how frequently you come in contact with that specific allergen. If this is the case, a Medicare Part D plan will cover your allergy medication, as well as most other prescription drugs you require. Depending on your Part D plan, you may have to pay an annual deductible before the Part D begins paying its share, as well as a copayment per prescription.5Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 23, 2021

Summary

Medicare will provide coverage for allergy testing if you have shown signs of a bad reaction to a particular substance. After you have been tested positive for an allergy, you and your doctor can discuss a medical treatment plan, refer you to an allergist, and talk about ways of avoiding your allergy source. For example, you were allergic to latex, your doctor may recommend nitrile or vinyl substitutes.

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