Immunosuppressive Drugs

Coverage

Documentation

Reviews/Audits

  • Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review

Tips

Topic Details
Documentation
  • Suppliers have option to mail immunosuppressive drugs to beneficiary up to two days prior to anticipated discharge date from an inpatient stay. Delivery must be to a valid place of service and not another facility that does not qualify as beneficiary's home. Supplier must enter date of discharge as date of service on claim
  • Continued need is considered met upon a beneficiary qualifying for immunosuppressive drugs. Ongoing documentation is not required to show continued need for life of transplant
Billing
  • When a transplant cannot be located in Medicare's claim database, bill immunosuppressive claims with KX modifier to notify Medicare that documentation is on file that indicates date of transplant, services furnished are medically necessary, and that Medicare paid for transplant in accordance with statue. KX modifier is not required but Medicare will deny claim if claim indicating that transplant was paid for by Medicare Fee-For-Service cannot be identified

 

Last Updated Jul 02, 2018

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.