Medicare Determinations

September 13, 2011 at 6:28 pm

Yes, it is essential that anyone on Medicare have a thorough understanding of the purpose of an ABN. In particular, how an ABN affects your pocket book, and that of the provider.

However, in response to your original question regarding plasmapheresis see the following:

1. Medicare National Coverage Determinations Manual


If you cannot open a .pdf document please download either the free Adobe Reader or the free Foxit PDF reader.

After you open the document go to section 110.14 Aspheresis (Therapeutic Pheresis) Section B, bullet #10 (or so)

2. For clarification on why some procedures were denied, in the past, please see: [url][/url]

In the article the explanation includes this “…[I]On occasion, Medicare contractors have denied payment for apheresis services based upon the lack of evidence that the apheresis professional was personally present to the patient during the entirety of the procedure….”[/I]

It is helpful to read the entire article to understand the reasoning, and resolution, of this roadblock.

Another document, dated Dated November, 2000 the [U]Medicare Coverage Issues Manual [/U] also has inf on this. See section 35-60 bullets 10 and 13

here: [url][/url]