AFO & KAFO Coverage policy
Ankle-foot orthoses (AFO) and knee-ankle foot orthoses (KAFO) are covered under the Medicare Braces Benefit. For coverage under this benefit, the orthosis must be a… Read More »AFO & KAFO Coverage policy
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Medical Coverage Guidelines
National Breast Cancer Awareness Month
October is National Breast Cancer Awareness Month. During this national health observance, CMS reminds health professionals that breast cancer is the second most common form… Read More »National Breast Cancer Awareness Month
Documentations Requirements for Boniva, Zometa, Reclast, Prolia and Xgeva
Bisphosphonate therapy:The following bisphosphonate injections (administered IV) are considered medically reasonable and necessary when administered as outlined below. The coverage of IV bisphosphonates must be… Read More »Documentations Requirements for Boniva, Zometa, Reclast, Prolia and Xgeva
will-medicare-pay-physicians-giving.html
A second opinion is when a doctor other than the patient’s regular doctor gives his or her view about patient’s health problem and how it… Read More »will-medicare-pay-physicians-giving.html
Medicaid coverage for Fluoride Varnish
What is fluoride varnish? Fluoride varnish is a protective medication that is painted on teeth to help prevent new cavities and help stop cavities that… Read More »Medicaid coverage for Fluoride Varnish
The revised Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, Mandatory use date: November 1, 2011
The revised Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers (including independent laboratories), physicians, practitioners, and suppliers in situations where Medicare… Read More »The revised Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, Mandatory use date: November 1, 2011
Black Lung Disease Coverage and Limitations
Coal workers’ pneumoconiosis (CWP), colloquially referred to as black lung disease that results from breathing in dust from coal, graphite, or man-made carbon over a long period… Read More »Black Lung Disease Coverage and Limitations
PROVENGE – 2011 updates – Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer
The Centers for Medicare & Medicaid Services (CMS) finds that the evidence is adequate to conclude that the use of autologous cellular immunotherapy treatment –… Read More »PROVENGE – 2011 updates – Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer