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Local Coverage Determinations (LCDs) for allergen immunotherapy go into effect

August 17, 2015

Local Coverage Determinations (LCDs) for allergen immunotherapy go into effect

Are you located in Arkansas, Colorado, Delaware, Louisiana, Maryland, Mississippi, New Mexico, New Jersey, Oklahoma, Pennsylvania, Texas, Washington D.C., or part of northern Virginia? Then the following information applies to you.

On August 13, the Local Coverage Determinations (LCDs) for allergen immunotherapy, that Novitas, a Medicare contractor for a number of States, recently published, went into effect .

An LCD is a determination by a Medicare carrier as to the conditions under which a particular item or service is covered. LCDs are intended to define the reasonable and necessary conditions of coverage allowed for the indicated services. Failure to follow the rules and guidelines outlined in the LCD could result in audits and denial of your claims.

The Advocacy Council of ACAAI (formerly JCAAI) had the opportunity to make comments on the proposed LCD – most of which were adopted in the final version.

In particular, there was an initial proposal to require “direct personal supervision” by a physician for vial preparation. This would have required the physician’s personal presence in the room where and when vials were being made. The Advocacy Council objected and suggested the standard be “direct supervision” which is the current rule and requires a physician’s presence in the office suite where the vials are being prepared. The carrier accepted our suggestion, and the standard remains “direct supervision.”

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