Medicare in Texas

March 17, 2008 at 3:24 pm

The default Medicare carrier in Texas is Trailblazers. Here is their official position of ivig for the treatment of cidp as of 2/18/2008. Coverage is possible through inpatient, outpatient, home health care, physicial services, or rural health services – but they must be approved medicare providers (not all hospitals are, for example). In our experience, we found the hospital inpatient/outpatient the least hassle, and payment rates for the providers were greater than other venues.

If your daily activities are seriously impaired, you will be covered – it takes good documentation and sometimes a letter from your doctor stating medical necessity.

– article L17363

Chronic Inflammatory Demyelinating Polyneuritis (CIDP)

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.