Wiki Chemotherapy Drug Codes

[krssy70]

I have a drug code that is being denied for not medical necessary. J1440. Injestion of Filgrastim, 300 mg. This drug is adminstered because the pt isn't producing enough white blood cells and this drug produces the white blood cell for the patient. The patient has had this drug injected 4 days in a row. Medicare paid for one and denied the other 3 for not medical necessary. Does anyone know if there are any policies on the CMS website?

 

[ciphermed]

There is a policy on the CMS (NGS/contractor) web-site under...

"Drugs and Biologicals, Coverage of, for Label and Off-Label Uses"
L25820

Imbedded within the LCD you should find...
A48208 - Filgrastim, Pegfilgrastim (e.g., Neupogen®, Neulasta TM) - Related to LCD L25820

http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=25820&lcd_version=32&show=all

Hope this helps,