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2009 Archival Library

February 1, 2009 - Medical Policy Unit Part A & B Updates


L25820
- Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

R6 (Effective February 1, 2009): Internal: The following article has been added: A48420 - Intravenous Iron Sucrose and Iron Dextran. No notice period required and none given.

Drug Article Corrections

A46089 - Temsirolimus (Torisel ™) – Related to LCD L25820
Correction (published 01/08/2009): ICD-9-CM code 197.7 has been added to the ICD-9-CM tables and the description for ICD-9-CM code 197.0 has been corrected in the "ICD-9-CM codes that are Covered" section of the article. These were inadvertently missed when the ICD-9-CM codes were added to the article in October. The year “2009” has been corrected in the first guideline under the “For claims submitted to the carrier or Part B MAC” section.

A46095 - Bevacizumab (e.g., Avastin™) - Related to LCD L25820
Correction (published 01/15/2009): the effective date for ICD-9-CM codes 362.07, 362.16 and 362.83 has been changed to 07/18/2008. The terminology for ICD-9-CM codes 191.0-191.9 has been corrected.

A46758 - Paclitaxel (e.g., Taxol®/Abraxane ™) - Related to LCD L25820
Correction (published 01/15/2009): the expanded indication for albumin-bound paclitaxel has been corrected to include recurrent breast cancer.

A46096 - Zoledronic Acid (e.g., Zometa ®, Reclast® ) – Related to LCD L25820
Correction (published 01/15/2009): ICD-9-CM codes 995.29 and V12.79 have been removed from the article on the CMS Medicare Coverage Database. These ICD-9-CM codes should have been removed from the secondary ICD-9 table for the management of osteoporosis as a consequence of the endocrine (including aromatase inhibitors) treatment of malignancy with the last revision.

A46754 - Alteplase Recombinant (e.g., Cathflo® Activase ®) – Related to LCD L25820
Correction (published 01/29/2009): the description for ICD-9-CM code 410.72 has been corrected on the Web site version to match what is listed in the CMS Medicare Coverage Database.

A47582 - Bortezomib (e.g., Velcade®) – Related to LCD L25820 - Correction (published 01/29/2009): the description for ICD-9-CM code 273.3 has been corrected on the Web site version to match what is listed in the CMS Medicare Coverage Database.

A47586 - Etoposide (Etopophos®, Toposar®, Vepesid®, VP-16) – Related to LCD L25820 - Correction (published 01/29/2009): the description for ICD-9-CM codes 183.3 and 183.5 have been corrected on the Web site version to match what is listed in the CMS Medicare Coverage Database.

A46103 - Gemcitabine Hydrochloride (e.g., Gemzar®) – Related to LCD L25820
Correction (published 01/29/2009): the description for ICD-9-CM codes 239.6, 239.8 and 239.9 has been corrected on the Web site version to match what is listed in the CMS Medicare Coverage Database.

A47579 - Ifosfamide (Ifex) - Related to LCD L25820 - Correction (published 01/29/2009): the spelling of the word “brain” has been corrected for ICD-9-CM code 198.3 on the version published on the Web site.

A47381 - Intravenous Immune Globulin (IVIG) - Related to LCD L25820
Correction (published 01/29/2009): a duplicate statement in the “ICD-9-CM Codes that are Covered” section has been removed. The word “Limitations” has been changed to “Indications” in the following statement: “For ICD-9-CM codes: 042, 283.0, 283.10, 283.19, 283.9, 287.30, 287.31 and 996.85 please refer to the “Indications” section for specific age requirements.”

A46105 - for Intravenous Iron Therapy (Sodium Ferric Gluconate) – Related to LCD L25820 - Correction (published 01/29/2009): HCPCS code J1756 has been removed from the article on the CMS Medicare Coverage Database. The description for ICD-9-CM codes 280.1 and V66.2 has been corrected on the Web site version to match what is listed in the CMS Medicare Coverage Database.

A46104 - Micafungin Sodium (e.g., Mycamine™) – Related to LCD L25820
Correction (published 01/29/2009): the description for ICD-9-CM code V07.8 has been corrected on the Web site version to match what is listed in the CMS Medicare Coverage Database.

A46088 - Omalizumab (e.g., Xolair®) – Related to LCD L25820 - Correction (published 01/29/2009): the description for ICD-9-CM code 995.3 has been corrected on the Web site version to match what is listed in the CMS Medicare Coverage Database.

A46756 - Oxaliplatin (e.g., Eloxatin®) - Related to LCD L25820 - Correction (published 01/29/2009): the description for ICD-9-CM codes 183.3 and 183.5 have been corrected on the Web site version to match what is listed in the CMS Medicare Coverage Database.

A46738 - Pamidronate Disodium for Injection (e.g., Aredia®) - Related to LCD L25820
Correction (published 01/29/2009): the description for ICD-9-CM code V58.69 has been corrected on the Web site version to match what is listed in the CMS Medicare Coverage Database.



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