Reply To: Problems with IVIG

February 21, 2016 at 1:31 am

I did spend some serious time looking into HSCT. I had originally applied in 2013. Then learned about the new ACA law scheduled for 1/1/2014. Without the new law my chances of getting Medicare to cover HSCT were nill.

The ACA covers clinical trials, but only for life-threatening diseases approved in advance.

Standard Medicare part A and B coverage does not apply to clinical trials as of 1/1/2014 when the ACA redefined coverage. The new ACA section 2709 defines coverages for clinical trials where cancer or other life-threatening disease are present. GBS/CIDP is not generally considered life-threatening.

The new ICD-10 billing codes are to be used when applying for coverage on form CMS 1450. Codes such as 59992 lodging, 59994 transportation, 59996 meals are all excluded from coverage, as is the related cost of a caregiver.

100% coverage for items considered “covered” is still possible, but I think the net result will be closer to 80% coverage IF the life-threatening provision can be brought into play.

Thanks for your always thoughtful, unbiased, and helpful posts!