About this policy
CMS National Coverage Determination | ncd_id=311 | manual_section=200.1 | coverage_level_code=2 | national_coverage_type=True | under_review=True | lab_ncd=False
Coverage indications
B. Nationally Covered Indications N/A C. Nationally Non-Covered Indications Effective for dates of service on or after March 2, 2006, the Centers for Medicare & Medicaid Services has determined that there is sufficient evidence to conclude that the use of Nesiritide for the treatment of CHF is not reasonable and necessary for Medicare beneficiaries in any setting. D. Other Effective for dates of service on or after March 2, 2006, this determination applies only to the treatment of CHF and does not change Medicare Administrative Contractor discretion to cover other off-label uses of Nesiritide or use consistent with the current FDA indication for intravenous treatment of patients with acutely decompensated CHF who have dyspnea at rest or with minimal activity.
Documentation requirements
Item/Service Description: A. General Nesiritide (Natrecor®) is Food and Drug Administration (FDA)-approved for the intravenous treatment of patients with acutely decompensated congestive heart failure (CHF) who have dyspnea (shortness of breath) at rest or with minimal activity. Nesiritide is not self-administered. Revision History: 04/2006 - Issued NCD for Nesiritide for Treatment of Heart Failure Patients. Effective date: 03/02/2006. Implementation date: 05/22/2006. ( TN 51 ) (CR4312) Benefit Categories: 33 - Incident to a physician's professional Service; 35 - Inpatient Hospital Services Transmittal: transmittal_number=51 | transmittal_issue_date=2006-04-07 | change_request_number=4312
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
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