Coverage Update: ESA Therapy for Drug-induced Anemia

Noridian Administrative Services has clarified its coverage policy for chemotherapeutic drugs that may cause chemotherapy-induced anemia.

Erythropoiesis stimulating agent (ESA) therapy may be used to treat anemia caused by the administration of J9000 series drugs and others listed here used for the treatment of cancer, in accordance with the National Coverage Determination (NCD) for ESA (NCD 110.21), Local Coverage Determination (LCD) and instruction on darbepoetin alfa (Aranesp®, DPA) and epoetin alfa (Epogen®, Procrit®, EPO) provided by the Centers for Medicare & Medicaid Services (CMS).

Special requirements for coverage of darbepoetin in the treatment of anemia due to myledoysplastic syndrome (MDS) have been eliminated. Medicare may now cover either erythropoietin or darbepoetin for the treatment of MDS-associated anemia.

The guidelines in Noridian’s article are intended to be used in conjunction with ICD-9-CM Official Guidelines for Coding and Reporting.

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