Is Allergy Testing Covered by Medicare?

What allergy tests does Medicare cover?

Medicare only covers allergy testing proven to provide accurate and effective results for specific types of allergens.

Skin prick testing

Medicare commonly covers percutaneous tests (skin tests involving puncturing, pricking, or scratching) leading to IgE-mediated reactions to suspected allergens, such as certain foods, inhalants, insect stings, and medications.

To be covered, you need to fulfill the following:

1. Your doctor needs to review your complete medical history and do a physical exam before ordering the test.
2. There must be evidence that the test results will be reliable based on scientifically valid peer-reviewed studies.
3. There needs to be a reasonable likelihood of you being exposed to the antigens in your day-to-day life.

If the percutaneous tests are negative, your doctor may suggest intracutaneous or intradermal testing. These tests involve injecting a small amount of an allergen into your skin.

Other tests

Medicare may also cover a few other types of allergy testing. In each case, it may depend on your particular Medicare plan, the specific allergen being tested for, and your doctor’s certification that the testing is necessary, reasonable, and part of a treatment program. These tests include:

• Patch testing: This is a commonly used method for diagnosing allergic contact dermatitis.
• Photo patch testing: This evaluates for photosensitivity disorders.
• Skin Endpoint Titration (SET) Testing or Intradermal Dilutional Testing (IDT): These tests determine your starting dose for allergy shots (immunotherapy).
• Delayed hypersensitivity skin testing: This looks for a delayed allergic reaction and is typically used for only a few specific known allergens or pathogens.
• Inhalation bronchial challenge: This looks at whether you experience a reaction to inhaling certain substances.
• Ingestion (oral) challenge: This is a test for reactions to food.
• Blood tests for certain allergies: These may be covered when medically necessary and ordered and performed by a doctor.

Talk with your doctor to see if Medicare will cover your particular allergy testing needs and treatment. Depending on the type of test, there may be limits on the scope or number of tests you can receive.

What isn’t covered

Some types of allergy testing are considered experimental and not medically necessary, which means they are unlikely to be covered by Medicare.

These include certain antibody tests, ingestion tests performed at home, laboratory tests, and food allergy tests administered under the tongue. The Centers for Medicare & Medicaid Services provides a more thorough list of what isn’t covered.

Medicare allergy coverage

Allergy services are typically covered by Medicare Plan B (medical insurance) or Medicare Plan D (prescription drug coverage).

Medicare Part B

Medicare Part B is part of Original Medicare. The monthly premium for Medicare Part B is $174.70 in 2024, and the annual deductible is $240. Once you’ve paid those premiums and deductibles, Medicare typically pays 80%, and you pay 20% of approved costs.

Medicare Part D

Medicare Part D is outside of Original Medicare. It’s purchased from a private insurance company that’s Medicare approved. Part D typically covers the self-administered prescription drugs not covered by Original Medicare. Premiums depend on the company from which you purchase Part D and the coverage your policy offers.

Medicare Part C (Medicare Advantage)

Medicare Part C (Medicare Advantage) is purchased from a private insurance company and bundles parts A and B and often Part D into a single comprehensive plan. It may also cover extra benefits not offered by Medicare, such as vision and dental care.

How much do allergy tests cost on Medicare?

How much your allergy testing will cost before and after Medicare coverage depends on the healthcare professional. It may also depend on:

• other insurance coverage, such as Medicare Advantage
• Medicare and other insurance premiums, deductibles, coinsurance, and copays
• doctor charges
• doctor acceptance of assignment (Medicare-approved price)

That said, one 2023 study of 270,831 people insured by Original Medicare found that those who received a measurement of specific IgE, which is a blood test that checks for food allergies, paid slightly less ($161) than those who underwent a skin prick test ($247).

Ask your doctor if the test they’re recommending is covered by Medicare. If it is, ask your doctor how much it will cost.

Takeaway

Certain types of allergy testing are often covered under certain circumstances. That said, check with your doctor before undergoing an allergy test to make sure the test is covered under your Medicare plan and to find out how much it will cost.