This Policy version was replaced on October 28, 2024. To find the newest version, go to https://www.bluecrossmn.com/providers/medical-management, select 'See Medical and Behavioral Health Policies', then 'Blue Cross and Blue Shield of Minnesota Medical and Behavioral Health Policies'. This will bring up the Medical Policy search screen. Enter the policy number without the version number (last three digits).
Sublingual immunotherapy (SLIT) is a method of allergy immunotherapy that has been proposed as an alternative to conventional subcutaneous immunotherapy injections. Allergen extracts used for SLIT are prepared in drop or tablet form and are administered under the tongue for absorption through the sublingual and buccal mucosa. SLIT is being investigated for treatment of a variety of allergic disorders, including those caused by seasonal, insect, and food allergies.
Depending on the results of allergy testing, SLIT drops may be single or multiple allergen extract drops. The drops are typically held under the tongue for a few minutes and then swallowed or spit out. Patients often take SLIT drops several times a week, sometimes daily, and continue taking them for years in order to develop long-term immunity. SLIT drops are usually self-administered in the home. The U.S. Food and Drug Administration (FDA) has not approved SLIT drops for any indication.
NOTE: This policy does not address sublingual immunotherapy tablets for allergy treatment, including FDA-approved sublingual immunotherapy tablets (e.g., Grastek®, Ragwitek®, Oralair® and Odactra®).
Sublingual immunotherapy drops are considered EXPERIMENTAL/INVESTIGATIVE for allergy treatment due to the lack of clinical evidence demonstrating an impact on improved health outcomes.
No additional statements.
Blue Cross and Blue Shield of Minnesota medical policies apply generally to all Blue Cross and Blue Plus plans and products. Benefit plans vary in coverage and some plans may not provide coverage for certain services addressed in the medical policies. When determining coverage, reference the member’s specific benefit plan, including exclusions and limitations.
Medicaid products may provide different coverage for certain services, which may be addressed in different policies. For Minnesota Health Care Program (MHCP) policies, please consult the MHCP Provider Manual website.
Medicare products may provide different coverage for certain services, which may be addressed in different policies. For Medicare National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and/or Local Coverage Articles, please consult CMS, National Government Services, or CGS websites.
Note that services with specific coverage criteria may be reviewed retrospectively to determine if criteria are being met. Retrospective denial of claims may result if criteria are not met.
Blue Cross and Blue Shield of Minnesota reserves the right to revise, update and/or add to its medical policies at any time without notice. Codes listed on this policy are included for informational purposes only and are subject to change without notice. Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement.
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Acknowledgements:
CPT® codes copyright American Medical Association® 2023. All rights reserved.
CDT codes copyright American Dental Association® 2023. All rights reserved.
