AFO & KAFO Coverage policy

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 rigid or semi-rigid device, which is used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of…

Documentations Requirements for Boniva, Zometa, Reclast, Prolia and Xgeva

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 supported in the medical record. The documentation should include the following information:• Criteria for the diagnosis of osteoporosis, and• History of treatment as related to progression of disease and ongoing…

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, 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 payment is expected to be denied. The revised ABN replaces the ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB (Form CMS-20007). See the revised ABN manual instructions below for detailed…

Black Lung Disease Coverage and Limitations

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 of time. Coal worker’s pneumoconiosis occurs in two forms: simple and complicated (Progressive Massive Fibrosis (PMF)). The symptoms are Chronic cough and Shortness of Breath The Department of Labor’s Black Lung…

PROVENGE – 2011 updates – Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer

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 – Sipuleucel-T; PROVENGE® improves health outcomes for Medicare beneficiaries with asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone refractory) prostate cancer. It is therefore reasonable and necessary to use for this on-label…