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Tufts Health Plan covers allergy immunotherapy when medically necessary and appropriately documented. Members need a referral from their primary care physician (PCP) and preauthorization from Tufts. Documentation should demonstrate a history of allergic reactions and the failure of standard treatments. Skin or blood testing is required to confirm specific allergens.
Coverage includes:
- Preparation of allergenic extracts.
- Injection schedules following standard protocols.
- Office visits for injections; typically, build-up phase and maintenance.
Restrictions include:
- Non-standard allergy testing methods are not covered.
- Over-the-counter treatments and non-specific immunotherapy are excluded.
- Services must be provided by a network allergist.
Always verify with Tufts for potential changes or updates to coverage.
Want to try immunotherapy?
Start with CurexReview your allergy test results with a Curex allergist.
1. Contact Tufts Health Plan: Call Member Services using the number on your insurance card.
2. Verify Coverage: Ask about "allergy immunotherapy coverage specifics" under your plan.
3. Reference Code: Mention CPT codes 95165 for serum and 95115/95117 for injections to aid in benefit determination.
4. Documentation: Inquire what documentation is necessary from your allergist to facilitate coverage.
5. Pre-authorization: Ask if a pre-authorization is required for the treatment.
6. Network Providers: Confirm you're seeing an in-network allergist for maximum benefits.
7. Out-of-pocket Costs: Request information on copays, deductibles, and co-insurance for treatments.
8. Follow Up: Obtain a reference number for your call and document who you spoke with for future reference.
Begin with these steps to ensure you have a clear understanding of your benefits and know how to proceed with your allergy immunotherapy process with Tufts Health Plan.
Treatment prescribed
by clinician
Clinicaly made allergen extracts are customized for your allergies
Your immune system gets desensitized to allergens, giving you long-term relief.