Billing and Coding: Allergen Immunotherapy

Allergen immunotherapy is covered only when it meets the reasonable and necessary criteria in LCD L36240 and when billing follows CMS Medicare Claims Processing guidance. Detailed medical record documentation is required (legible records, provider signature, support for ICD-10/CPT/HCPCS codes, therapeutic expectations, antigen levels, dosing/dilution referenced to maintenance concentrate); additional documentation (informed consent and training validation) is required for home administration.

"Allergen immunotherapy is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination (LCD) L36240."

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