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).

June 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.
 
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

June 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 June 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 June 2018
 
Retired Policies/Article - There are no retired Policies/Articles for June 2018
 
Revised Policies/Articles - June 2018