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).

August, 2018 - The re-work of the NCD is still pending at the CMS level - No update available.  No problems reported by members.
 
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. 

August 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 August 2018. Additional details about these updates are available in the full article on our website.
 
Please note: These changes will not be reflected in the LCDs and coverage articles until July 26, 2018.
 
New Policies/Articles - Effective August 1, 2018
Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)
 
Retired Policies/Articles - Effective August 1, 2018
Billing and Coding for Rezum® Procedure 

Revised Policies/Articles - Effective as Indicated
Erythropoiesis Stimulating Agents (ESAs) and Billing and Coding Guidelines - Effective July 1, 2018
High Intensity Focused Ultrasound (HIFU) in the Treatment of Recurrent Prostate Cancer - Effective August 15, 2018
MolDX: Molecular Diagnostic Tests (MDT) - Effective August 1, 2018
MolDX: ThermoFisher Oncomine Dx Target Test for Non-Small Cell Lung Cancer, Coding and Billing Guidelines - Effective August 1, 2018
Non-Invasive Cerebrovascular Studies - Effective August 1, 2018
Not Otherwise Classified Chemotherapy Agents (NOC) - Effective April 1, 2018