Does Medicare Cover Allergy Shots? Part B, CPT Codes & What You'll Pay

No, Medicare Part D does not cover allergy shots. Allergy shots are covered under Medicare Part B, not Part D. Part D covers prescription medications you pick up at a pharmacy and take yourself. For Medicare coverage purposes, allergy shots are classified as physician-administered outpatient medical procedures reimbursed when delivered in a medical facility with 30-minute post-injection monitoring for anaphylaxis. This Part B classification means your regular Part B deductible ($240 in 2024) and 20% coinsurance apply, not your Part D drug cost-sharing structure. (Separately, an at-home program like Curex provides the same SCIT shot at home for a $129/month cash-pay subscription with a prescribed epinephrine auto-injector confirmed on hand and Zoom-supervised dosing; because it is not billed to Medicare, no Part B coinsurance applies.) If you have a standalone Part D plan, it will not contribute to allergy shot costs. Confirm coverage details with your specific Medicare plan before starting treatment.

Medicare uses two primary billing code categories for allergy shots. CPT code 95115 covers professional services for a single allergen injection, while CPT 95117 covers two or more injections in a single visit — the relevant code when you receive bilateral arm injections. Allergen extract preparation (mixing your personalized serum) is billed separately under CPT codes 95120-95134, depending on the number of doses prepared. Both the injection administration and extract preparation are Part B covered services. When reviewing your Explanation of Benefits, you may see multiple line items per visit because Medicare reimburses these components separately. The Medicare Physician Fee Schedule sets the approved amounts for each code, which allergists who accept Medicare assignment must use as their billing ceiling.

Under Original Medicare Part B, prior authorization is generally not required for allergy immunotherapy injections. However, if you are enrolled in a Medicare Advantage (Part C) plan, prior authorization requirements vary significantly by plan and by insurer. HMO-type Medicare Advantage plans frequently require prior authorization and may also require a primary care physician referral before you can see a specialist allergist. PPO-type Advantage plans typically have fewer restrictions but still often require prior authorization for ongoing immunotherapy. Before starting allergy shot treatment, contact your Medicare Advantage plan's member services to confirm prior authorization requirements, in-network allergist availability, and applicable copay or coinsurance amounts. For Original Medicare beneficiaries, the primary administrative step is confirming your allergist accepts Medicare assignment.

For Original Medicare beneficiaries, the out-of-pocket cost per allergy shot visit depends on whether you've met your annual Part B deductible ($240 in 2024). Once the deductible is met, you typically pay 20% of the Medicare-approved amount for each visit. The Medicare-approved rate for a single injection (CPT 95115) ranges from approximately $8-15, meaning your 20% share is roughly $1.60-3.00 for the injection component alone. Extract preparation fees are billed separately. Total out-of-pocket per visit under Original Medicare typically runs $5-25 once deductible is met. Medicare Advantage plans often charge fixed specialist copays of $20-40 per visit, regardless of the underlying service costs. Patients with Medigap supplemental coverage may have their 20% coinsurance covered entirely, reducing per-visit costs to near zero.

Yes, Medicare Part B covers the 30-minute post-injection observation period as part of the allergy shot office visit. The observation period is a medically required component of allergy immunotherapy — the AAAAI practice parameters mandate in-office monitoring after every injection to manage anaphylaxis if it occurs. Because the observation period is an integral part of the procedure, it is included in the CPT code billing rather than billed as a separate service. You will not see a separate charge for the monitoring time on your Explanation of Benefits. This is one reason why allergy shot visits typically take 45-60 minutes total: the actual injection takes under 5 seconds, plus 30 minutes of observation, plus check-in and documentation time. Medicare does not cover observation time for at-home self-injections, which is one reason home injection is not a covered Medicare benefit.

Medicare Advantage plans cannot deny coverage for services that Original Medicare Part B covers, including allergy shots. However, they can impose conditions such as prior authorization requirements, network restrictions, and step therapy requirements (demonstrating that antihistamines and nasal steroids have already been tried). If a Medicare Advantage plan denies a prior authorization request for allergy immunotherapy, you have the right to appeal. The appeals process starts with an internal plan appeal, and if denied, can escalate to an independent review entity and ultimately to federal administrative law judges. Plans must provide a denial notice with appeal instructions. If your current Medicare Advantage plan creates significant barriers to allergy care, you may be able to switch plans during the annual Medicare Open Enrollment period (October 15 - December 7 each year).

Yes, Medicare Part B covers allergy skin testing (CPT 95004 for percutaneous skin prick testing) as the diagnostic step before starting immunotherapy. You must have documented IgE-mediated sensitization before Medicare will cover allergy shots — the testing visit establishes the medical necessity. Skin testing is typically performed during an allergist office visit, billed under the same 80/20 Part B cost-sharing structure after your deductible. Specific IgE blood testing (such as ImmunoCAP) is also covered under Part B for medically appropriate diagnostic workup. The allergen testing is a separate visit from the first injection visit and is billed independently. For patients seeking a more convenient initial testing option, at-home testing platforms can provide the preliminary sensitization data your allergist needs before ordering comprehensive in-office testing.