Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

SCIT for aeroallergens is covered for patients with allergic rhinitis/conjunctivitis and/or allergic asthma who have symptoms on natural exposure and demonstrable specific IgE, after optimization of environmental control and pharmacotherapy. Initiation requires a documented trial of pharmacotherapy/allergen avoidance (minimum 28 days) or other qualifying reasons, with typical maintenance therapy of 3–5 years and periodic evaluation every 6–12 months; SCIT is not covered in the absence of clinically relevant IgE, during pregnancy, for food sensitivities, for atopic dermatitis, or as first-line therapy without prior treatment. Documentation must include physician examination/authorization, detailed extract preparation and component information, and facilities/providers must be equipped and trained to manage anaphylaxis; select exceptions (e.g., equivocal testing, home administration) require case-by-case review.

"Allergic rhinitis and/or allergic conjunctivitis (seasonal or perennial) are indications for SCIT when other criteria below are met."