tci Part B Insider - 2007 Issue 26

PHYSICIAN NOTES: Don't Take New ESA Coverage Limits Lying Down

Learn the new reason codes and rescue your crossover claimsYou should be contacting your member of Congress during the August recess to protest Medicare's new coverage decision on the use of erythropoiesis stimulating agents (ESAs) to treat anemia in cancer patients, the American Society of Clinical Oncology (ASCO) urges.Among the problems with the new policy: It restricts ESA coverage when a patient's hemoglobin goes above 10 grams per deciliter, which is different from the Food & Drug Administration-s (FDA-s) guidelines. The policy allows dose escalation of 25 percent for hypo- or non-responders, which also goes against FDA guidelines...

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