LCD/NCD Portal

NCD110.14

 

APHERESIS (THERAPEUTIC PHERESIS)

 

Effective Date of this Version

7/30/1992

 

Benefit Category

• Incident to a physician's professional Service.

• Outpatient Hospital Services Incident to a Physician's Service.

• Physicians' Services.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Item/Service Description

A - General

• Apheresis (also known as pheresis or therapeutic pheresis) is a medical procedure utilizing specialized equipment to remove selected blood constituents (plasma, leukocytes, platelets, or cells) from whole blood.

o The remainder is retransfused into the person from whom the blood was taken.

• For purposes of Medicare coverage, apheresis is defined as an autologous procedure, i.e., blood is taken from the patient, processed, and returned to the patient as part of a continuous procedure (as distinguished from the procedure in which a patient donates blood preoperatively and is transfused with the donated blood at a later date).

 

Indications and Limitations of Coverage

 

Indications

• Apheresis is covered for the following indications:

o Plasma exchange for acquired myasthenia gravis.

o Leukapheresis in the treatment of leukemia.

o Plasmapheresis in the treatment of primary macroglobulinemia (Waldenstrom).

o Treatment of hyperglobulinemias, including (but not limited to) multiple myelomas, cryoglobulinemia and hyperviscosity syndromes.

o Plasmapheresis or plasma exchange as a last resort treatment of thromobotic thrombocytopenic purpura (TTP).

o Plasmapheresis or plasma exchange in the last resort treatment of life threatening rheumatoid vasculitis.

o Plasma perfusion of charcoal filters for treatment of pruritis of cholestatic liver disease.

o Plasma exchange in the treatment of Goodpasture's Syndrome.

o Plasma exchange in the treatment of glomerulonephritis associated with antiglomerular basement membrane antibodies and advancing renal failure or pulmonary hemorrhage.

o Treatment of chronic relapsing polyneuropathy for patients with severe or life threatening symptoms who have failed to respond to conventional therapy.

o Treatment of life threatening scleroderma and polymyositis when the patient is unresponsive to conventional therapy.

o Treatment of Guillain-Barre Syndrome.

o Treatment of last resort for life threatening systemic lupus erythematosus (SLE) when conventional therapy has failed to prevent clinical deterioration.

 

Settings

• Apheresis is covered only when performed in a hospital setting (either inpatient or outpatient) or in a nonhospital setting, e.g., a physician directed clinic when the following conditions are met:

o A physician (or a number of physicians) is present to perform medical services and to respond to medical emergencies at all times during patient care hours.

o Each patient is under the care of a physician.

o All nonphysician services are furnished under the direct, personal supervision of a physician.

 

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