Medicare does pay

Igoalen,

I remember the agony of getting appropriate care for my 20 yr old daughter. A lot of our details will not be relavent to your mother, but I was (am) determined to find answers. Here is some info and links to the hair-splitting details of obtaining ivig and continuing care for a loved one in Texas w/cidp.

Trailblazers is the default Medicare carrier for Texas. The coverage policy was updated in June ’07. Here is a descriptive summary of the current policy:

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The diagnosis of this condition must be documented in the medical record and must be consistent with published diagnostic criteria for this condition.

– The patient has unequivocal CIDP, as defined by the mandatory clinical and physiologic or pathologic criteria of the American Academy of Neurology (Neurology 41: pp. 617-618, 1991) or from the Medical Advisory Committee of the Neuropathy Association (J Peripheral Nervous Assn, 2003, 8:282-284);
– The patient has proved refractory to, or intolerant of, prednisone or azathioprine given in therapeutic doses over at least three months.
– The patient has a neurologic function assessment score of at least three or greater on the Rankin Scale at the time of initial therapy.

IVIG will not be covered as an initial therapy for patients with newly diagnosed CIDP, or as maintenance therapy in patients failing to respond to an initial course of IVIG following therapies with other agents. An exception to IVIG as an initial therapy would be in patients with severe CIDP (Rankin scores of 4 or 5) in whom a rapid therapeutic response is deemed medically desirable or in any patient meeting coverage criteria above (bullets one and three) for whom immunosuppressives are contraindicated. Patients responsive to an initial course of IVIG will be eligible for maintenance therapy coverage only if unequivocal neurological deterioration occurs at some future point in time.

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This is the link to search any questions you have on medicare coverage (remember to search in Texas):

[url]http://www.cms.hhs.gov/mcd/search.asp?clickon=search[/url]

Here is the link to Trailblazer’s coverage on ivig:

[url]http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=17363&lcd_version=39&show=all[/url]

Some things to consider in your mother’s situation:

You did not mention what kind of facility she was at when she received the 3 days of ivig. It can make a big difference. They have to be approved medicare providers – many hospitals, outpatient centers, and infusion centers are. Private providers and home services are a little more difficult to qualify for medicare payments.

If your mother’s daily activities are seriously impaired, she will be covered – it takes good documentation and a letter from your doctor stating the necessity – we had to do this. From your post, it sounds like your mother could have contraindications for the steriods if they are affecting her eyes. I would discuss that with her doctor and include it in his letter requesting maintenance ivig therapy.

Hope this helps,
Best wishes
cd