Allergen Immunotherapy to Medicare Beneficiaries: Use of Professional Society Practice Parameters
Provider Types Affected
All physicians and providers who submit Medicare claims for providing Allergen Immunotherapy to Medicare Beneficiaries are affected.
Provider Action Needed
This special edition (SE) article SE 0812 is in response to recommendations made by the Department of Health and Human Services (DHHS), Office of Inspector General (OIG) in its 2006 'Allergen Immunotherapy for Medicare Beneficiaries' report. This article provides guidance and resources, developed by professional societies, for Medicare contractors and providers in determining the most appropriate provisions of allergen immunotherapy to Medicare beneficiaries.
Background
The Centers for Medicare & Medicaid Services (CMS) does not have a national coverage determination (NCD) that identifies national coverage criteria for allergen immunotherapy services. Currently coverage of allergen immunotherapy services is at the local Medicare contractor's discretion. The February 2006 'Allergen Immunotherapy for Medicare Beneficiaries' report released by the DHHS, OIG identified areas of Medicare vulnerability due to insufficient available information regarding coverage, coding, and documentation requirements for physicians who provide allergen immunotherapy to Medicare beneficiaries.
Key Points
- Because allergen immunotherapy may vary significantly based on geographical locations, CMS, with the support of the Joint Council of Allergy, Asthma and Immunology (JCAAI), decided that an NCD was not the best mechanism for providing coverage to beneficiaries throughout the nation
- CMS determined that contractor discretion for coverage of allergen immunotherapy is most appropriate
- Without an NCD, Medicare contractors may develop their own local coverage determinations (LCDs)
- While these policies may vary between contractors, CMS strongly encourages physicians who provide allergen immunotherapy to closely follow practice parameters agreed upon and endorsed by the professional societies that represent allergy, asthma and immunology practitioners (like the Joint Council of Allergy, Asthma, and Immunology (JCAAI)), as long as those parameters fall within the coverage criteria of applicable LCDs
- Specific practice parameters are provided on the JCAAI Web site at www.jcaai.org/ and are important for all practitioners and providers to study and understand
Additional Information
The CMS Web site provides a searchable database of LCDs, which is available at
www.cms.hhs.gov/mcd/search.asp.
Providers may also wish to review the Medicare NCD Manual, which is available at
www.cms.hhs.gov/Manuals/IOM/list.asp.