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State Medicare Guidelines / CMS 1500
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| Legal Notice: This document is presented for informational purposes only and is not intended to provide reimbursement or legal advice. Laws, regulations and policies concerning reimbursement are complex and are updated frequently. While we have made an effort to be current as of the issue date of this document the information may not be as current or comprehensive when you view it. Please consult with your counsel or reimbursement specialist for any reimbursement or billing questions. |
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Please refer to the National Coverage Determination (NCD) for additional information that may supercede the Medicare guidelines provided by your local Medicare Carrier, Fiscal Intermediary, or Medicare Administrative Contractor (MAC).
Summary - MAC
- Updated March 10, 2010
For additional information on Medicare covered indications for your specific state, please see the appropriate Medicare Administrative Contractor (MAC) Local Coverage Determinations/Supporting Documentation which may be accessed through the link above or by clicking here.
Part A for your state has two payers which process claims. If you use WPS (formerly Mutual of Omaha), please select it now.
WPS If you do not use WPS, or if you need Part B information, the Medicare guideline summary for your Medicare Administrative Contractor (MAC) is below.
| Indication |
ICD-9-CM |
HCPCS |
Starting Labs |
Ending Labs |
GFR/Serum Creatinine |
Allowable Dosage |
Post Chemo |
| Cancer (chemo) |
285.3 and secondary malignancy code
Link
Link |
J0885
Link |
Not Stated
Link |
Not Stated
Link |
SC: Not Applicable
GFR: Not Applicable |
Not Stated |
Not Stated |
| AIDS/AZT |
284.89 and 042 or 079.53
Link |
J0885
Link |
HCT < 30% or Hb < 10 g/dL
Link |
Hb 10-12 g/dL
Link |
SC: Not Applicable
GFR: Not Applicable |
Not Stated |
Not Applicable |
| Renal |
285.21 and 403.00 403.01, 403.10, 403.11, 403.90, 403.91, 404.00, 404.01, 404.02, 404.03, 404.10, 404.11, 404.12, 404.13, 404.90, 404.91, 404.92, 404.93, 585.3, 585.4 or 585.5
Link |
J0885
Link |
Not Stated |
Hb 10-12 g/dL
Link |
Creatinine clearance < 60 mL/min or GFR < 60 mL/min/1.73m^2
Link |
Not Stated |
Not Applicable |
| Surgery (hip or knee) |
285.29 or 285.9 and V07.8
Link |
J0885
Link |
Hb between 10 and 13 g/dL
Link |
Not Stated |
SC: Not Applicable
GFR: Not Applicable |
Not Stated |
Not Applicable |
These summaries have been prepared using the Medicare Administrative Contractor (MAC) guidelines. If you would like to receive the MAC Medicare guidelines, you can call PROCRITline® at 1-800-553-3851 or you can contact the payer directly at the web address in the State Medicare Payers box above.
R140
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