Part B Insider (Multispecialty) Coding Alert

Coverage:

Medicare Pumps Up Insulin Coverage

Older patients can now benefit from stem cell transplants

The Centers for Medicare & Medicaid Services plans to expand coverage for four vital therapies that could help your patients. They are:
 
Carotid artery stenting, which CMS will cover for patients who can't undergo the alternative therapy, known as carotid endarterectomy (CEA), because it would be too risky for them. Carotid artery stenting is less invasive than CEA, and involves using a catheter to place the stent to widen an artery that fatty deposits or plaques have narrowed.

  • Patients must have at least 70 percent symptomatic narrowing of the carotid artery, or else they must be in a clinical study. Also, CMS will only cover the procedure for facilities and providers that have demonstrated competence in the procedure and follow-up care.

  • Abaralix, for patients undergoing palliative treatment for prostate cancer. Patients must not be appropriate for luteinizing hormone-releasing hormone (LHRH) agonist therapy and they must refuse surgical castration. They must also have one or more symptoms, including risk of neurological compromise due to metastase, obstruction of the urethra or bladder outlet, or severe bone pain from skeletal metastases.

  • Autologous stem cell transplants for AL Amyloidosis. CMS already covered this treatment for patients aged 63 and under at the carrier's discretion, and now Medicare will cover the treatment for older patients as well. Autologous stem cell transplantation involves retrieving stem cells from a patient's bone marrow or blood, storing them, and then transplanting them back into the patient after high-dose chemotherapy. Patients must meet three specific criteria regarding the extent of their disease, especially the involvement of the kidneys or heart.

  • Insulin infusion pumps for diabetes. Medicare has covered these pumps since 1999 for patients with specific levels of C-peptide in their blood, and now CMS will also consider a different test, known as beta cell autoantibody. The new test can identify more patients with Type I diabetes who could benefit from insulin infusion pumps.
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