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LCD ID Number: L34313 Status: A-Approved
LCD Title: Allergy Testing
Geographic Jurisdiction: Nevada Other Jurisdictions
Original Determination Effective Date:
10/01/2015
Original Determination Ending Date:
Revision Effective Date:
10/01/2019
Revision End Date:
CMS National Coverage Policy:
Title XVIII of the Social Security Act (SSA), 1862(a)(1)(A), states that no Medicare payment shall be made for items or services that “are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.”
Title XVIII of the Social Security Act, 1862(a)(7) and 42 Code of Federal Regulations, §411.15, exclude routine physical examinations.
Title XVIII of the Social Security Act, 1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.
CMS Manual System, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §110.11; food allergy testing and treatment.
CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, §200; allergy testing and immunotherapy.
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