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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

Medicare Administrative Contractor (MAC) Jurisdictions Information

The Centers for Medicare & Medicaid Services (CMS) is integrating the administration of Medicare Parts A and B for the fee-for-service benefit to new entities called Medicare Administrative Contractors (MACs). To learn more about the status of this program in your state, select your state from the drop down menu, or visit the CMS website.

Jurisdiction State* Award Date Status MAC Jurisdiction Status State Specific Status
1 California, Hawaii, and Nevada October 25, 2007 Transition Complete Palmetto GBA (Palmetto) Palmetto GBA was awarded the contract for Jurisdiction 1 (J1) A/B MAC. Palmetto assumed full responsibility for the work in September 2008.
Link		  
2 Alaska, Idaho, Oregon, and Washington May 6, 2008 Contract Awarded National Heritage Insurance Corporation (NHIC) CMS awarded the Jurisdiction 2 (J2) A/B MAC contract to National Heritage Insurance Corporation.
Link 		 
3 Arizona, Montana, North Dakota, South Dakota, Utah, and Wyoming July 31, 2006 Transition Complete Noridian Administrative Services, LLC (NAS) CMS announced that it had awarded the Jurisdiction 3 (J3) A/B MAC contract to Noridian Administrative Services. NAS assumed full responsibility for the work in March 2007.
Link 		 
4 Colorado, New Mexico, Oklahoma, and Texas August 2, 2007 Transition Complete TrailBlazer Health Enterprises, LLC (Trailblazer) CMS announced that it had awarded the Jurisdiction 4 (J4) A/B MAC contract to TrailBlazer Health Enterprises. Trailblazer assumed full responsibility for the work in June 2008.
Link		  
5 Iowa, Kansas, Missouri, and Nebraska September 5, 2007 Transition Complete Wisconsin Physicians Service Health Insurance Corporation (WPS) CMS announced that it had awarded the Jurisdiction 5 (J5) A/B MAC contract to Wisconsin Physicians Service Health Insurance Corporation. WPS assumed full responsibility for the work in June 2008.
Link		  
6 Illinois, Minnesota, and Wisconsin January 7, 2009 Contract Awarded Noridian Administrative Services, LLC (NAS) CMS announced it had awarded Noridian Administrative Services, LLC the contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 6 (J6).
Link		  
7 Arkansas, Louisiana, and Mississippi   See CMS   See CMS
Link		  
8 Indiana and Michigan January 7, 2009 Contract Awarded National Government Services, Inc. (NGS) CMS announced it had awarded National Government Services, Inc. the contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 8 (J8).
Link		  
9 Florida September 12, 2008 Transition Complete First Coast Service Options, Inc (FCSO) CMS announced it had awarded the contract for Jurisdiction 9 (J9) to First Coast Service Options, Inc. FCSO assumed full responsibility for the work in March 2009.
Link		  
10 Alabama, Georgia, and Tennessee January 7, 2009 Transition Complete Cahaba GBA, LLC (Cahaba) CMS announced it had awarded Cahaba GBA, LLC the contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 10 (J10). Cahaba assumed full responsibility for the claims processing workload in September 2009.
Link		  
11 North Carolina, South Carolina, Virginia, and West Virginia January 7, 2009 Contract Awarded Palmetto GBA, LLC (Palmetto) CMS announced it had awarded Palmetto GBA, LLC the contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 11 (J11).
Link		  
12 Delaware, District of Columbia, Maryland, New Jersey, and Pennsylvania October 24, 2007 Transition Complete Highmark Medicare Services, Inc. (HMS) Highmark Medicare Services, Inc. was awarded the contract for Jurisdiction 12 (J12) A/B MAC. HMS assumed full responsibility for the work in December 2008.
Link		  
13 Connecticut, and New York March 18, 2008 Transition Complete National Government Services (NGS) National Government Services was awarded the contract for Jurisdiction 13 (J13) A/B MAC. NGS assumed responsibility for the work in November 2008.
Link		  
14 Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont November 19, 2008 Transition Complete National Heritage Insurance Corporation (NHIC) CMS announced it had awarded the contract for Jurisdiction 14 (J14) to National Heritage Insurance Corporation. NHIC assumed full responsibility for the work in June 2009.
Link		  
15 Kentucky and Ohio January 7, 2009 Contract Awarded Highmark Medicare Services, Inc (HMS) CMS announced it had awarded Highmark Medicare Services, Inc. the contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 15 (J15).
Link
* Does not include U.S. territories; see CMS for further information

The information provided presents no statement, promise, or guarantee by Centocor Ortho Biotech Inc. concerning levels of reimbursement, payment, or charge. Please consult your payer organizations with regard to local or actual coverage and reimbursement policies and determination processes.



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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from the United States of America. © Centocor Ortho Biotech Inc. 2010 Last modified: 08/05/10