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Date Printed: August 18, 2017: 07:59 PM

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Subject: Allergy Testing and Immunotherapy

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This medical coverage guideline is not an authorization, certification, explanation of benefits, or a guarantee of payment, nor does it substitute for or constitute medical advice. All medical decisions are solely the responsibility of the patient and physician. Benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered. This medical coverage guideline applies to all lines of business unless otherwise noted in the program exceptions section.

 

DESCRIPTION

An allergy occurs when a substance causes an unwanted reaction in the body’s immune system. These reactions can range from watering eyes and runny nose to swelling and difficulty breathing. In some cases, an allergic reaction can be life threatening. Substances that can cause allergic reactions are called allergens. They can include pollen, dust, mold, animal dander, insect sting venom, food or drugs.

Allergy Testing

Allergy testing is commonly used to identify the cause of an allergy. There are two types of allergy testing. The first type, called in vivo testing, exposes the person to allergens in a controlled way including:

  • Skin prick or scratch testing
  • Skin patch testing
  • Injection testing
  • Breathing provocation tests
  • Food challenges

The second type of allergy testing is called in vitro testing. In this type, the blood is examined for antibodies to certain allergens or chemicals that can occur as a result of exposure to an allergen.

Immunotherapy

Allergy immunotherapy is a treatment for allergies. After allergy testing identifies the allergen, increasing doses of an allergen extract are given over time. This allows the body to develop immunity to the effects of the allergen. These doses lead up to a maintenance dose, which may be given regularly for several years.

Visit the Clinical View of this guideline for more information.

Visit WebMD for more information on allergy testing and immunotherapy.

COVERAGE

 

Note: For all medical decisions about this service, Florida Blue uses the Position Statement in the Clinical View of this medical coverage guideline. To make the best decision for your health needs, talk to your doctor. The services covered vary from health plan to health plan. Refer to your health plan contract for complete information about your coverage.

 

Several types of allergy tests may be covered if certain requirements are met.

Certain allergy immunotherapy services may be covered if certain requirements are met for:

• Evaluating your condition for the supply or administer an allergen extract

• Monitoring your physical status while administering the extract

• Supplies (needles, syringes, diluents)

Professional services for allergen immunotherapy may include:

• Supervising, preparing and providing extracts

• Administrating extracts

Note: Some types of allergic immunotherapy are not covered.

Visit the Clinical View of this guideline for specific coverage information.

PROGRAM EXCEPTIONS

• Federal Employee Program (FEP): Certain exceptions apply.

• State Account Organization (SAO): Certain exceptions apply.

• Medicare Advantage products: Certain exceptions apply.

Visit the Clinical View of this guideline for more coverage information.

Refer to your health plan contract for complete information about your coverage.

Date Printed: August 18, 2017: 07:59 PM