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 who have symptoms on natural exposure and demonstrable specific IgE, and who meet at least one additional criterion such as poor response to ≥28 days of pharmacotherapy/avoidance, unacceptable medication adverse effects, or patient preference. SCIT is contraindicated or not covered for absence of clinically relevant IgE, atopic dermatitis, SLIT, pregnancy, food sensitivities, and non-aeroallergen uses (eg, venom); an initial maintenance course of 3–5 years is standard with evaluations every 6–12 months and treatment not reimbursed if no benefit after 2 years. Documentation must include clinical evidence of exposure-related symptoms, specific IgE testing, optimization of prior therapies, physician-prepared antigen records (MD/DO), and detailed extract composition and handling information.

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