Oncology & Hematology Coding Alert

Drug Reimbursement:

Verify That LCA Pay Rates Are History for Lupron Depot

Check your LCDs for information on J9217 reimbursement.Has your practice checked that it's being adequately reimbursed for Lupron Depot? CMS determined it will no longer enforce least costly alternative (LCA) policies, which could be good news for you. Make sure you have all the details to ensure your practice gets the money you deserve.Expect Full Pay as of April 19, 2010In February, CMS lost a lawsuit regarding its LCA policy. Not long after, Medicare sent contractors an instruction that they must pay for Part B drugs according to the particular drug the patient actually received, not the price of the lowest cost alternative drug for which they were paying in the past. History: The U.S. Court of Appeals for the D.C. Circuit sided with a Medicare beneficiary in the case of Hays v. Sebelius, which involved Medicare denying a patient a prescribed treatment for her lung disease. Medicare decided to [...]
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