Cyanocobalamin (Vitamin B-12 injections, J3420) is reimbursed by Medicaid at the point of sale (without prior authorization) for dialysis patients only. However, if the patient has a diagnosis of pernicious anemia a prior authorization request may be submitted for review.
REVIEW CRITERIA: (All of the following must be met)
1. Confirmed diagnosis of Pernicious Anemia
2. Dosing should follow these standard practice guidelines:
Adults: 100 mcg IM/SC once daily for one week. Following clinical improvement, give 100 mcg IM/SC on alternate days for 7 doses, then every 3—4 days for another 2—3 weeks, then 100 mcg IM monthly for life.
Children: 30—50 mcg IM/SC once daily for 2 or more weeks until a total cumulative dose of 1000—5000 mcg IM/SC has been given, then maintenance of 100 mcg IM/SC once every 4 weeks.
Reference: http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/drug_creteria_pdf/Cyanocablamin.pdf
Blogger Widget
Popular Posts
-
Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbur...
-
An OPPS payment status indicator is assigned to every HCPCS code. The status indicator identifies whether the service described by the H...
-
Therapeutic activities are considered medically necessary for patients needing a broad range of rehabilitative techniques that involve ...
-
Claim Adjustment Reason Codes (CARC) CO-22 or PR-22 This care may be covered by another payer per coordination of benefits. CO-19 This is...
-
This procedure is medically necessary only when it requires the professional skills of a therapist, is designed to address specific ne...
-
Ambulance transportation is a covered service when the patient’s condition is such that the use of any other method of transportation would...
-
Health benefit payers, including Medicare, are limited to use of those internal and external code sets identified in the implementation gui...
-
Mohs surgery, also known as chemosurgery, created by a general surgeon, Dr. Frederic E. Mohs, is performed to remove complex or ill-defi...
-
AAPC’s Certified Professional Coder (CPC) credential is the gold standard for medical coding in physician office settings and held by more ...
-
CIGNA will adopt a common time frame for health care professionals to follow for submitting claims to CIGNA. Except where state law requir...
