Part B Insider (Multispecialty) Coding Alert

Published on Wed Jun 08, 2011 PDF

You'll no longer have to wait for case-by-case determinations on whether your MAC will cover Provenge® for your seriously ill prostate cancer patients. CMS has issued a final coverage decision indicating that it will cover cellular immunotherapy, or sipuleucel-T (brand name Provenge®) effective immediately.

CMS will cover Provenge® for FDA-approved uses including treating asymptomatic or minimally symptomatic metastatic castrate resistant prostate cancer. Previously, the treatment was covered only on a case-by-case basis by local contractors.

Ever since CMS introduced its PQRS program, many practices have told CMS that they've faced difficulty understanding the intricacies of the system, with some complaining that they've been hesitant to participate because it's too confusing.

But CMS aims to quell those concerns with three new educational resources about the program. The first, a PQRS Claims Registry Fact Sheet, offers guidance on claims-based and registry-based reporting, and shows you the steps you should take to get the lowdown on PQRS.

The second document discusses how to participate in PQRS's Preventive Care Measures Group, and the third shows you the Reporting Periods for 2011.

To gain access to the documents, visit www.cms.gov/PQRS and select the "educational resources tab." Then click "downloads" and select the appropriate publication.