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Contractor Information

Contractor Name: Noridian Healthcare Solutions, LLC - Full list of policies of this Medicare Contractor Contractor Number: 02201 Contractor Type: MAC A

LCD Information

LCD ID Number: L40052 Status: R- Retired LCD Title: Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT) Geographic Jurisdiction: Idaho Other Jurisdictions Original Determination Effective Date: 10/26/2025 Original Determination Ending Date: 11/06/2025 Revision Effective Date: Revision End Date: CMS National Coverage Policy: Title XVIII of the Social Security Act, §1862 (a)(1)(A) allows coverage and payment for only those items or services that are considered to be medically reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §20.2 Physician Expense for Allergy Treatment, §50.2 Determining Self-Administration of Drug or Biological and §50.4.4.1 Antigens CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 16, §90 Routine Services and Appliances CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 2, §110.9 Antigens Prepared for Sublingual Administration and §110.11 Food Allergy Testing and Treatment CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, §200 Allergy Testing and Immunotherapy Sorry, you need to login or register to view additional sections of this Medicare policy. *