tci Part B Insider - 2004 Issue 29

Drug Reimbursement: Your CHF Clinic May Lose One Treatment Method Soon

 Carriers remove coverage for Natrecor in office settingIf your office is running a congestive heart failure clinic and providing infusions of Natrecor (Nesiritide), then you should keep an eye on carrier bulletins. Some carriers have already declared that they won't reimburse J2324 (Injection, nesiritide, 0.5mg) in the office setting, because clinical trials only addressed the treatment's effectiveness in the inpatient setting. These carriers include Cahaba GBA as well as Palmetto GBA, which was paying for Natrecor on a case-by-case basis until recently. "Since these patients need to be closely monitored for response to and side...

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