Allergen Immunotherapy
L36240
Allergen immunotherapy is covered for documented IgE‑mediated, clinically relevant allergies (e.g., allergic rhinitis, conjunctivitis, allergic asthma, dust mite atopic dermatitis, and stinging insect hypersensitivity) after a failed trial of avoidance; specific IgE testing must correlate with exposure history. Exclusions include food allergy immunotherapy, cockroach allergy, urticaria/angioedema, certain methods/routes (oral/sublingual for food, epicutaneous, intralymphatic, intranasal, sublingual generally), and whole‑body Hymenoptera extracts except fire ant; high‑risk comorbidities and home administration are restricted. Build‑up and maintenance schedules and duration (individualized, often 3–5 years) and documentation requirements (testing, history, failed avoidance, risk assessments, informed consent, provider scope) must be met, and patients must be observed for at least 30 minutes post‑injection.
"Allergen immunotherapy is medically reasonable when the patient has discernable evidence of specific IgE antibodies to clinically relevant allergens that correlate with the patient's exposure histo..."