PURPOSE:
This notice is intended to notify providers of the LCD 05-057 has been retired and replaced with LCD 06-038.
 
BACKGROUND:
Previously, Medicare Beneficiaries were eligible for the treatment of Rituximab for the following 11 indications:

1. Relapsed or refractory low grade or follicular B-cell non-Hodgkin's lymphoma, including mantle cell lymphoma (MCL);
2. Previously untreated, low-grade or follicular B-cell non-Hodgkin's lymphomas as a single agent, in combination with the CHOP regimen, or in combination with other agents active in this disease;
3. Relapsed or refractory diffuse aggressive non-Hodgkin's lymphoma, as a single agent, in combination with the CHOP regimen, or in combination with other agents active in this disease;
4. Previously untreated diffuse aggressive non-Hodgkin's lymphoma, as a single agent, in combination with the CHOP regimen or other agents active in this disease;
5. First line treatment of chronic lymphocytic leukemia, in combination with fludarabine and with fludarabine and cyclophosphamide;
6. Relapsed or refractory chronic lymphocytic leukemia;
7. Relapsed or refractory Waldenstrom's macroglobulinemia;
8. Immune or Idiopathic Thrombocytopenia Purpura;
9. Post-transplant lymphoproliferative disorder (PTLD);
10. Renal transplant
    • prophylaxis- reduction of renal transplant rejection (pre and post) by reducing HLA/ABO antibodies in highly sensitized patients
    • rejection- treatment of renal transplant rejection in severe, steroid resistant or HLA/ABO mediated rejection episodes following kidney transplantation;
11. Cardiac transplant
    • prophylaxis- reduction of cardiac transplant rejection (pre and post) by reducing HLA antibodies in previously sensitized patients
    • rejection- treatment of refractory humoral cardiac rejection.

LCD 06-038 has been updated to add indication number 12 for those Medicare Beneficiaries with: Moderately to severely-active rheumatoid arthritis who have had inadequate response to one or more TNF antagonist therapies when administered in combination with methotrexate to reduce signs and symptoms in adult patients.

CPT/HCPCS CODE:
The HCPCs is J9310 – Rituximab, 100MG.  It should also be noted that clinical trials identified by CMS and sponsored by the National Cancer Institute must contain the modifier QR for reporting anti-cancer drugs.

ICD-9 CODES THAT SUPPORT MEDICAL NECESSITY:
The following ICD-9 codes have been added to support the indication:

 
 
REVISION EFFECTIVE DATE:
This update is for services performed on or after 02/28/2006

In summary, the purpose of this notice is to update the provider community of the additional indication for the treatment of Rituximab and the use the modifier QR for the reporting of anti-cancer drugs.


REFERENCES:
LCD 06-038 - Rituximab

This bulletin should be shared with all health care practitioners and managerial members of the provider/supplier staff.  Additional copies may be downloaded from our website at www.highmarkmedicareservices.com

Countdown has begun; do you have your NPI? Don’t risk disruption to your cash flow – Get your NPI now! National Provider Identifiers (NPIs) will be required on claims sent on or after May 23, 2007. Every healthcare provider needs to get an NPI! Learn more about NPI and how to apply by visiting www.cms.hhs.gov/NationalProvIdentStand/ on the CMS website.

This page also contains a section for Medicare Fee-For-Service (FFS) providers with helpful information on the Medicare NPI implementation.  A Countdown Clock is now available on this page to remind health care providers of the number of days left before the compliance date; bookmark this page as new information and resources will continue to be posted.

For more information on private industry NPI outreach, visit the Workgroup for Electronic Data Interchange (WEDI) NPI Outreach Initiative website at http://www.wedi.org/npioi/index.shtml on the web.