Corporate Compliance

Transmittals and MLN Matters articles: CMS issues NCD for prostate cancer treatment, updates ESRD PPS, and more

Medicare Insider, July 19, 2011

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CMS makes quarterly update to ESRD PPS

On July 15, CMS issued a transmittal to make quarterly updates to the end-stage renal disease prospective payment system (ESRD PPS).

Effective date: The effective date for the ICD-9-CM updates is October 1, 2011; the effective date for the DME list corrections is January 1, 2011
Implementation date: October 3, 2011

View the transmittal.

CMS posts NCD for autologous cellular immunotherapy treatment of metastatic prostate cancer

On July 8, CMS issued two transmittals related to coverage of autologous cellular immunotherapy treatment - sipuleucel-T; PROVENGE®. CMS has concluded that sipuleucel-T improves health outcomes for Medicare beneficiaries with asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone refractory) prostate cancer, and thus is reasonable and necessary for this on-label indication.

Effective date: June 30, 2011
Implementation date: August 8, 2011 and January 3, 2012 (CWF frequency edit only)

View the National Coverage Determination Manual transmittal.

View the Claims Processing Manual transmittal.

CMS revises flu vaccine instructions

On July 8, CMS issued two transmittals to make changes to the Claims Processing Manual and the Benefit Policy Manual regarding the timing of the influenza vaccine.

Effective date: August 8, 2011
Implementation date: August 8, 2011

View the Claims Processing Manual transmittal.

View the Benefit Policy Manual transmittal.

CMS replaces transmittal

CMS rescinded and replaced a transmittal previously outlined in Medicare Weekly Update.



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