Allergen-Reducing Products for Children

Revised: September 25, 2026

· Overview

· Eligible Providers

· Third-Party Liability (TPL) and Medicare

· Eligible Members

· Covered Services

· Authorization

· Billing

· Reimbursement

· Legal References

Overview

Minnesota Health Care Programs (MHCP) covers certain allergen-reducing products for children with poorly controlled asthma.

Eligible Providers

The following may provide allergen-reducing products:

· Durable medical equipment providers

· Federally qualified health centers

· Home health agencies

· Indian Health Services

· Medical suppliers

· Pharmacies

· Public health nursing clinics

· Public health clinics

· Rural health clinics

An allergen-reducing product must be prescribed by one of the following MHCP-enrolled treating providers:

· Physician

· Physician assistant

· Advanced practice nurse

Health care professionals, such as registered environmental health specialists, healthy homes specialists, lead risk assessors, certified asthma educators, and public health nurses can make recommendations to MHCP-enrolled treating providers about allergen-reducing products for the child.

Third-Party Liability (TPL) and Medicare
Providers must meet any provider criteria, including accreditation, for third-party insurance or for Medicare to assist members for whom Minnesota Health Care Programs (MHCP) is not the primary payer.

MHCP quantity limits and thresholds apply to all members unless only Medicare coinsurance or deductible is requested. Refer to the Medicare and Other Insurance section of the MHCP Provider Manual for more information.

Eligible Members

All MHCP members under the age of 21 for Medical Assistance and under the age of 19 for MinnesotaCare who are diagnosed as having poorly controlled asthma are eligible. The Minnesota Legislature has defined a person as having poorly controlled asthma when they have experienced one of the following:

· A hospital emergency department visit for asthma at least once in the past year; or

· A hospitalization for the treatment of asthma at least once in the past year.

Refer to the Enhanced Asthma Care Services Act webpage through the Minnesota Department of Health for more information on the legislation and member eligibility.

Covered Services

All covered products require an order from a physician, physician assistant, nurse practitioner or clinical nurse specialist.

MHCP will cover the following allergen-reducing products:

· Allergen encasements for mattresses, box springs and pillows

· An allergen-rated vacuum cleaner, filters and bags

· A dehumidifier and filters

· A HEPA single-room air cleaner and filters

· Integrated pest management, including traps and starter packages of food storage containers

· A damp mopping system

· A waterproof hospital-grade mattress (if the member does not have access to a bed)

· Furnace filters (for homeowners only)

Authorization

MHCP does not require prior authorization for any allergen-reducing products.

Billing

Refer to Billing Policy Overview section of the MHCP Provider Manual for details.

· Bill all allergen-reducing products under miscellaneous code E1399. Use modifier HA to denote you are billing for a child. A child includes those age 21 and younger but you must also follow MinnesotaCare and Medicaid policy for who is considered a child.

· Include a manufacturer’s pricing document. (If this is not available, an invoice is acceptable documentation.)

· Use MN–ITS 837P Professional or X12 Batch.

Reimbursement

Reimbursement is the manufacturer’s suggested retail price minus 20%, or provider’s cost listed on the invoice plus 20%.

Legal References

Minnesota Statutes, 256B.0625, subdivision 31 (h) (Medical supplies and equipment)
Minnesota Statutes, 256B.0625, subdivision 67 (Enhanced asthma care services)