tci Part B Insider - 2003 Issue 35

DRUG REIMBURSEMENT: Presence of a Code Doesn't Guarantee Payment

New drug billing can be touch and go The Food & Drug Administration approved Natrecor (nesiritide) a few years ago, and it received a HCPCS Code in January 2003. But good luck billing J2324 to many Medicare carriers. Natrecor is the first of a new class of drugs known as human B-type natri-uretic peptides and is indicated for the intravenous treatment of patients with acutely decompensated congestive heart failure that causes shortness of breath. Studies have shown that Natrecor can improve breathing and heart function in these patients. But only two carriers have local medical review policies for Natrecor...

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