Question: I have read that some Medicare contractors allow reimbursement for extracorporeal immunoad-sorption therapy for treating rheumatoid arthritis. What is the correct code for reporting the procedure? New York Subscriber Answer: In a decision memorandum dated April 27, 2000, the Centers for Medicare and Medicaid Services (CMS) determined that extracorporeal immunoadsorption using protein A columns is a reasonable and necessary treatment for rheumatoid arthritis (RA). Previously, the protein A column therapy was covered only for idiopathic thrombocytopenic purpora (ITP). ICD-9-CM codes related to RA that support medical necessity include: Empire Medical's LMRP also lists a number of limitations, including:
According to the LMRP for Empire Medical Services, Medicare carrier for New York, code 36521 (Therapeutic apheresis; with extracorporeal affinity column adsorption and plasma reinfusion) should be used to report these procedures after Jan. 1, 2001. However, extracorporeal immunoadsorption using protein A columns is considered medically necessary and reasonable for RA only when the following conditions apply:
Most, but not all, Medicare contractors cover this service. It is best to ask your local Medicare and private carriers for their guidelines.