Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

Subcutaneous allergen immunotherapy (SCIT) for aeroallergens is covered for patients with allergic rhinitis/conjunctivitis and/or allergic asthma when symptoms correlate with natural exposure and specific IgE to the implicated allergen is demonstrated. Coverage requires prior optimization of environmental control and pharmacotherapy (or documented reasons for failure), meeting at least one specified clinical criterion (eg, inadequate control after ≥28 days of therapy, medication adverse effects, or patient preference), and adherence to provider, documentation, and facility requirements; an initial maintenance course of 3–5 years is recommended with periodic evaluation every 6–12 months and noncoverage if no benefit is evident after 2 years.

"SCIT using aeroallergen preparations is covered for allergic rhinitis and/or allergic conjunctivitis (seasonal, perennial, or both)."