Erythropoiesis Stimulating Agents (ESAs) LCD and Coding Medical Necessity Article Have Been Updated
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The Local Coverage Determination, Erythropoiesis Stimulating Agents (ESAs) has been updated. The special requirements for coverage of darbepoetin (DPA) used in the treatment of the anemia due to myelodysplastic syndrome (MDS) are eliminated. This update reflects the current Drug Compendia recognition of darbepoetin as an accepted indication for the treatment of the anemia of MDS. As a result, both erythropoietin (EPO) and DPA are covered for this indication. In addition, we clarified MDS coverage requirement #4 to ensure providers understood the absolute coverage exclusion if bone marrow blast count is >5%.
The related article, "Coding Medical Necessity: Erythropoiesis Stimulating Agents (ESAs) was updated to reflect the LCD and to clarify the section, "Chemotherapeutic Drugs that May Cause Chemotherapy-Induced Anemia". Both the J9000 series drugs and the additional attached list of specific drugs may cause an anemia related to the drugs' use as chemotherapeutics. The resulting anemia may be treated with ESA therapy.
The coding article is linked to the LCD from the URL in the section "LCD Attachments".
No codes have been added to or deleted from this LCD or the coding article.
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