Wiki Sublingual Allergy Drops

[cmasters]

Hey there! Does anyone know if Medicare covers sublingual allergy drops? Our patient is stating they do and I have always thought they did not.
Thank you

 

[csperoni]

Medicare does not cover. Per Medicare NCD Manual:

110.9 - Antigens Prepared for Sublingual Administration
(Rev. 1, 10-03-03)
CIM 45-28
For antigens provided to patients on or after November 17, 1996, Medicare does not cover such antigens if they are to be administered sublingually, i.e., by placing drops under the patient’s tongue. This kind of allergy therapy has not been proven to be safe and effective. Antigens are covered only if they are administered by injection.

 

[cmasters]

Medicare does not cover. Per Medicare NCD Manual:

110.9 - Antigens Prepared for Sublingual Administration
(Rev. 1, 10-03-03)
CIM 45-28
For antigens provided to patients on or after November 17, 1996, Medicare does not cover such antigens if they are to be administered sublingually, i.e., by placing drops under the patient’s tongue. This kind of allergy therapy has not been proven to be safe and effective. Antigens are covered only if they are administered by injection.

Thank you, how do I show proof of this to this patient? She said her medicare counselor told her they were covered. She is very argumentative.

 

[csperoni]

You could show her the Medicare NCD which I copied & pasted in my original response - it is 110.9.
https://www.cms.gov/medicare-covera...tails.aspx?NCDId=155&ncdver=1&bc=AAAAQAAAAAAA&

You should also have her sign a Medicare ABN form. Depending on her preference (which she indicates on the ABN), you can just bill her directly and not submit to Medicare, or have her pay and submit to Medicare with modifier GA.
https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN