Does Medicare Cover Allergy Testing?
Medicare can cover some allergy testing since it is a type of clinical lab test. For most clinical lab tests, you typically pay nothing if the test is ordered by a doctor or healthcare provider and proven to be a medical necessity.
Medicare Coverage of Allergy Testing
Medicare Part B will cover clinical and diagnostic lab tests like allergy testing if your doctor orders them. It must be medically necessary that you receive the test. Allergy tests will not be covered in all circumstances, and those that are may receive coverage differently.
Skin tests – also known as a percutaneous test – is quick, simple and one of the most common methods to identify different allergic reactions and conditions.
- Some drugs like penicillin
Medicare coverage could include other types of skin tests. An intradermal test, which injects a small amount of antigen into your skin, may be used if a percutaneous test doesn’t identify the cause of an allergic reaction. Intradermal tests can also be used to identify reactions to vaccines.
Patch testing can also be covered, typically only when diagnosing allergic contact dermatitis from specific allergens that touch your skin.
Medicare may also cover blood tests that identify similar allergies as skin tests, like inhalants, insects or food.
Additionally, Medicare coverage may extend to a blood test if a skin test proves unreliable, but not if you have already received a skin test to attempt to identify the same allergen.
Food Challenge Test
A food challenge test is done in a hospital or outpatient office and can be covered if it is medically necessary.
During the procedure, you eat increments of food while supervised by a doctor or healthcare provider. The goal is to determine precisely when an allergic reaction sets in.
Additional coverage or types of tests could be available through a Medicare Advantage plan. These plans are provided through private insurers, include everything featured under Original Medicare and have expanded coverage and benefits.
If you have Medicare Advantage, check with your plan provider to determine what additional allergy tests and coverage are available to you.
Allergies and allergic reactions may be treated with medication that Original Medicare does not cover. Medicare Part D, which is an optional benefit, does include prescription drug coverage for allergy medication.
What Causes Allergies and Allergic Reactions?
Allergies are caused by a wide-ranging number of allergens, from medicine to food or pollen. They are also common – ranked sixth in chronic illnesses in the U.S. according to the Asthma and Allergy Foundation of America – and can be severe.
Check with your doctor or healthcare provider to determine if you may need an allergy test to identify an allergen or cause of a reaction.
6 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2021, May 21). Local Coverage Determination (LCD): Allergy Testing. Retrieved from https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33261&ver=32&MCDIndexType=2&mcdtypename=Potential+National+Coverage+Determination+(NCD)+Topics&NCDId=266&ncdver=1&SearchType=Advanced&CoverageSelection=Both&NCSelection=NCA%257CCAL%257CNCD%257CMEDCAC%257CTA%257CMCD&ArticleType=Ed%257CKey%257CSAD%257CFAQ&PolicyType=Final&s=5%257C6%257C66%257C67%257C9%257C38%257C63%257C41%257C64%257C65%257C44&KeyWord=allergy+testing&KeyWordLookUp=Doc&KeyWordSearchType=Exact&kq=true&bc=IAAAAAgAAAAA&
- U.S. National Library of Medicine. (2021, May 17). Allergy. Retrieved from https://medlineplus.gov/allergy.html
- U.S. Centers for Medicare & Medicaid Services. (2020, November 18). Local Coverage Determination (LCD): Allergy Testing. Retrieved from https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=36402
- Asthma and Allergy Foundation of America. (n.d.). Allergy Facts and Figures. Retrieved from https://www.aafa.org/allergy-facts/
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Clinical laboratory tests. Retrieved from https://www.medicare.gov/coverage/clinical-laboratory-tests
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Proposed Local Coverage Determination (LCD): Allergy Testing. Retrieved from https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=38921&ver=16&DocType=1&bc=AACAAAAAAAAA&