Sedimentation Rate, Erythrocyte

Jurisdiction: J9 MAC Part B. States: Florida, Puerto Rico, US Virgin Islands. Type: Active LCD

History/Background and/or General Information The erythrocyte sedimentation rate (ESR) is a sensitive but nonspecific test that is frequently the earliest indicator of disease when other chemical or physical signs are normal. It is most often used as a gauge for determining the progress and detection of an inflammatory disorder caused by infection, autoimmune mechanisms, or connective tissue disease. Covered Indications An ESR will be considered medically reasonable and necessary for one of the following conditions: Aiding in the diagnosis of temporal arteritis (giant cell arteritis) and polymyalgia rheumatic Monitoring disease activity in temporal arteritis and polymyalgia rheumatica for the principal indication of adjusting the dosage of corticosteroids Monitoring patients with treated Hodgkin’s disease Monitoring patients with autoimmune diseases, inflammatory disorders caused by infection, or connective tissue diseases An ESR should be used selectively in patients with symptoms that are not explained by results of a careful history and physical examination. Rapid screen for elevated protein or globulin level in serum ESR may be used with or replaced by C-Reactive protein in evaluation of unexplained inflammatory states . Limitations This service is not medically necessary for screening purposes. As published in the CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4, an item or service may be covered by a contractor LCD if it is reasonable and necessary under the Social Security Act Section 1862 (a)(1)(A). Contractors shall determine and describe the circumstances under which the item or service is considered reasonable and necessary.