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Oncology & Hematology Coding Alert

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Will CMS Declare This $500,000 Procedure Noncovered?

Published on Wed Aug 16, 2006

Noridian wants BBBD chemo NCD If your oncologists use blood brain barrier disruption (BBBD) hoping to increase chemo drug concentration and prolong drug-brain tumor contact time, consider yourself on red alert.

Noridian has requested a National Coverage Determination for Medicare non-coverage of BBBD chemotherapy, claiming that the long-term effects of BBBD are unknown and that there's no data to show BBBD is superior to conventional chemo.

In the letter requesting the NCD, Noridian points out that the cost for each beneficiary receiving BBBD is about $500,000.

While Trailblazer has a Local Coverage Determination setting its non-coverage policy and Noridian has a non-coverage draft LCD, some other Medicare contractors are now paying for the procedure.

CMS opened a National Coverage Analysis to determine whether the treatment is reasonable and necessary for beneficiaries and expects to complete the NCA in April 2007.

Keep up on the latest on the NCA Tracking Sheet site, www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=188.
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