tci Medicare Compliance & Reimbursement - 2004 Issue 38

Cardiac Care: CHF Clinics Soon May Lose A Treatment Method

Carriers remove coverage for Natrecor in office setting. Physician offices running congestive heart failure clinics and providing infusions of Natrecor (Nesiritide) should keep an eye on upcoming carrier bulletins.Some carriers have already declared that they won't reimburse J2324 (Injection, nesiritide, 0.5mg) in the office setting, because clinical trials only addressed the treatment's effectiveness in the inpatient setting. These carriers include Cahaba GBA as well as Palmetto GBA, which was paying for Natrecor on a case-by-case basis until recently."Since these patients need to be closely monitored for response to and side effects of treatment, the medical literature...

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