Pending ESA NCD Problem - CMS released a new National Coverage Determination (NCD) 110.21, Erythropoiesis Stimulating Agents (ESAs) in Cancer and Change Request (CR) 10318 which included non-coverage of Anemia in chronic kidney disease (CKD) and Refractory Anemia with ring sideroblasts (Myelodysplastic Syndrome (MDS).

May 1, 2018 - The re-work of the NCD is still pending at the CMS level.  No WPS Medicare issues reported for use of ESAs based on their "ACTIVE" LCD which includes myelodysplasia and CKD.

April 2, 2018 - A conference call with MSHO and the American Society of Hematology (ASH) was held today to review the impact of the pending "reworking" of the NCD and the problems with some of the managed Medicare plans who have implemented the edits within the NCD.  Post-call, ASH will be reaching out to CMS to find out the timing of the updated NCD.  Watch this section of our newsletter for more information.

March 19, 2018 - Change Request (CR) 10318, Transmittal 2005 titled, "ICD-10 and Other Coding Revisions to National Coverage Determinations (NCDs)," released on January 18, 2018, contains the latest coding instructions to Centers for Medicare & Medicaid Services (CMS) NCDs. Business Requirement 10 specifically addresses coding changes for NCD 110.21, Erythropoiesis Stimulating Agents (ESAs) in Cancer.
 
CMS is in the process of re-reviewing the coding changes for NCD 110.21. Until this review is complete, and CMS makes a final determination, the A/B Medicare Administrative Contractors (MACs) will not implement the edits contained in CR 10318. The A/B MACs will also reprocess any claims that were processed in error from January 1, 2018, that were processed with the additional codes included in CR 10318 as not payable with the -EC modifier.

February 2018 - Important Changes in the NCD 110.21 ESA

UPDATE on the IMPORTANT Changes in the NATIONAL COVERAGE DETERMINATION 110.21 -ERYTHROPOESIS STIMULATING AGENTS

To read the complete article CLICK HERE

May 2018 Local Coverage Determination (LCD)/Coverage Article Updates

The following is a summary of the Local Coverage Determination (LCD) and Coverage Article updates made by WPS GHA for April 2018. Additional details about these updates are available in the full article on our website.
 
New Policies/Articles - There are no new Policies/Articles for May 2018
 
Retired Policies/Article - Effective: 01/01/2018           
MolDX: Chromosome 1p/19q Deletion Analysis
 
Revised Policies/Articles - Effective as Indicated:
Coenzyme Q10 Testing - Effective 05/01/2018
MolDX: APC and MUTYH Gene Testing - Effective 05/01/2018
MolDX: ConfirmMDx Epigenetic Molecular Assay - Effective 05/01/2018
MolDX: Immunohistochemistry (IHC) Indications for Breast Pathology - Effective 05/01/2018
MolDX: Prolaris™ Prostate Cancer Genomic Assay - Effective 01/01/2018
MolDX: ProMark Risk Score - Effective 05/01/2018
Self-Administered Drug Exclusion List (SAD List) - Effective 01/01/2018