LCD/NCD Portal

NCD20.5

 

EXTRACORPOREAL IMMUNOADSORPTION (ECI) USING PROTEIN A COLUMNS

 

Effective Date of this Version

1/1/2001

 

Benefit Category

• Outpatient Hospital Services Incident to a Physician's Service

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

 

Item/Service Description

• Extracorporeal immunoadsorption (ECI), using Protein A columns, has been developed for the purpose of selectively removing circulating immune complexes (CIC) and immunoglobulins (IgG) from patients in whom these substances are associated with their diseases.

• The technique involves pumping the patient's anticoagulated venous blood through a cell separator from which 1-3 liters of plasma are collected and perfused over adsorbent columns, after which the plasma rejoins the separated, unprocessed cells and is retransfused to the patient.

 

Indications and Limitations of Coverage

• For claims with dates of service on or after January 1, 2001, Medicare covers the use of Protein A columns for the treatment of ITP.

• In addition, Medicare will cover Protein A columns for the treatment of rheumatoid arthritis (RA) under the following conditions:

o Patient has severe RA. Patient disease is active, having >5 swollen joints, >20 tender joints, and morning stiffness >60 minutes.

o Patient has failed an adequate course of a minimum of 3 Disease Modifying Anti-Rheumatic Drugs (DMARDs). Failure does not include intolerance.

• Other uses of these columns are currently considered to be investigational and, therefore, not reasonable and necessary under the Medicare law. (See §1862(a)(1)(A) of the Act.)

 

Claims Processing Instructions

• TN 1811 (Medicare Intermediary Manual)

• TN 1679 (Medicare Carriers Manual)

 

Coverage Transmittal Link

• http://www.cms.gov/transmittals/downloads/R127CIM.pdf

National Coverage Analyses (NCAs)

National Coverage Analyses (NCAs)

• This NCD has been or is currently being reviewed under the National Coverage Determination process.

• The following are existing associations with NCAs, from the National Coverage Analyses database.

• Original consideration for Extracorporeal Immunoadsorption Using Protein A Columns for Rheumatoid Arthritis (CAG-00057N)

 

Medicare NCD Link