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Introduction Commercial Payer Prior Authorization Medicare Part D Prior Authorization Please see full Prescribing Information, including Boxed WARNINGS, for PROCRIT® (Epoetin alfa) Medicare Guideline Archives Medicare Guideline Update Table CMS 1450 / UB-04

State Medicare Guidelines / CMS 1500
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PROCRIT BILLING

Introduction

Welcome

Many payors have developed billing and reimbursement guidelines that set forth criteria for determining how and what claims are paid for and under what criteria. These guidelines vary from payor to payor, and you can receive specific information by directly contacting the individual payor. The Centers for Medicare and Medicaid Services (CMS), formerly known as The Health Care Financing Administration (HCFA), is a major payor. CMS carriers (Medicare Part B) and fiscal intermediary (Medicare Part A) guidelines are provided on this website.



National Coverage Determination (NCD)

The Centers for Medicare & Medicaid Services (CMS) has released the final National Coverage Determination (NCD) for Erythropoesis Stimulating Agents (ESA). It is effective 7/30/2007, and its implementation date is 4/7/2008. The NCD is a result of a Change Request. The Change Request is the document that CMS has issued to Medicare contractors to provide direction concerning the implementation of the National Coverage Decision. Please refer to the NCD for additional information that may supercede the Medicare guidelines provided by your local Medicare Carrier, Fiscal Intermediary, or Medicare Administrative Contractor (MAC). To view the NCD, click here or to visit the CMS ESA policies page click here. Contact your Medicare Contractor (Carrier, Fiscal Intermediary, or MAC) or PROCRITline (1-800-553-3851) for additional information.



State Medicare Guidelines / CMS 1500

CMS is a major payor in health care. Many private payors model their coverage after CMS, so understanding their policies is vital for your practice. Current PROCRIT guidelines for both Medicare Part A and Part B by state are included with each summary. See the Summaries below.





Medicare Guideline Archives

Medicare Guideline Archives keeps track of the previous state summary guidelines to help you handle past bills and payment issues.



Medicare Guideline Update Table

Visit our Medicare Guideline Update Table to view the latest revision dates for the summary guidelines found on this site.



CMS 1450 Example

Visit our CMS 1450 Example to view the Medicare Hospital Outpatient Sample Claim Form (CMS 1450 UB-04).



Important Safety Information for PROCRIT® (Epoetin alfa)

WARNINGS: INCREASED MORTALITY, SERIOUS CARDIOVASCULAR EVENTS, THROMBOEMBOLIC EVENTS, STROKE and INCREASED RISK OF TUMOR PROGRESSION OR RECURRENCE

Chronic Renal Failure:
  • In clinical studies, patients experienced greater risks for death, serious cardiovascular events, and stroke when administered erythropoiesis-stimulating agents (ESAs) to target hemoglobin levels of 13 g/dL and above.

  • Individualize dosing to achieve and maintain hemoglobin levels within the range of 10 to 12 g/dL.
Cancer:
  • ESAs shortened overall survival and/or increased the risk of tumor progression or recurrence in some clinical studies in patients with breast, non-small cell lung, head and neck, lymphoid, and cervical cancers (see WARNINGS: Table 1).

  • To decrease these risks, as well as the risk of serious cardio- and thrombovascular events, use the lowest dose needed to avoid red blood cell transfusion.

  • Because of these risks, prescribers and hospitals must enroll in and comply with the ESA APPRISE Oncology Program to prescribe and/or dispense PROCRIT® to patients with cancer. To enroll in the ESA APPRISE Oncology Program, visit www.esa-apprise.com or call 1-866-284-8089 for further assistance.

  • Use ESAs only for treatment of anemia due to concomitant myelosuppressive chemotherapy.

  • ESAs are not indicated for patients receiving myelosuppressive therapy when the anticipated outcome is cure.

  • Discontinue following the completion of a chemotherapy course.
Perisurgery: PROCRIT® (Epoetin alfa) increased the rate of deep venous thromboses in patients not receiving prophylactic anticoagulation. Consider deep venous thrombosis prophylaxis.

(See WARNINGS: Increased Mortality, Serious Cardiovascular Events, Thromboembolic Events, and Stroke, WARNINGS: Increased Mortality and/or Increased Risk of Tumor Progression or Recurrence, INDICATIONS AND USAGE, and DOSAGE AND ADMINISTRATION.)

Please see full Prescribing Information, including Boxed WARNINGS for PROCRIT® (Epoetin alfa)

Medication Guide for PROCRIT®
Please read the Medication Guide for PROCRIT® and discuss with your doctor.

Patient Instructions for Use
Instructions if you or your caregiver has been trained to give PROCRIT® injections at home.




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CPT codes, descriptions and material only are copyright 2010 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS Restrictions Apply to Government Use.

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