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.  
 
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.

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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

July 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 July 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 July 2018

• MolDX: AlloSure Donor-Derived Cell-Free DNA Test - Effective August 16, 2018
• MolDX: EndoPredict® Breast Cancer Gene Expression Test - Effective August 16, 2018
• MolDX: FDA Approved CLL Companion Diagnostic Test Coding and Billing Guidelines - Effective August 15, 2018
• MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk
• Prostate Cancer - Effective August 16, 2018

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

• Category III Codes - Effective July 1, 2018
• Erythropoiesis Stimulating Agents (ESAs) and Billing and Coding Guidelines - Effective May 15, 2018 (Biosimilar Additions)
• MolDX: CDH1 Genetic Testing Coding and Billing Guidelines - Effective July 1, 2018
• MolDX: Myriad's BRACAnalysis CDx® Coding and Billing Guidelines - Effective July 1, 2018