Does Medicare cover Erythropoiesis Stimulating Agents (ESAs), Epoetin alfa (EPO) or Darbepoetin alfa (DPA), for patients who were anemic prior to starting chemotherapy?
WPS Medicare does not cover ESAs (EPO or DPA) for cancer-induced anemia. The anemia must be due to the chemotherapy itself, whether the chemotherapy is being used to treat cancer or another illness such as hepatitis, multiple scleroses, etc. Treatment of myeloid malignancies is an exception. Medicare considers reimbursement for ESAs (EPO and DPA) for chemotherapy-induced anemia. When billing for chemotherapy-induced anemia, Medicare requires three diagnosis codes.
Related Questions
- Does Medicare cover Erythropoiesis Stimulating Agents (ESAs), Epoetin alfa (EPO) or Darbepoetin alfa (DPA), for patients who were anemic prior to starting chemotherapy?
- I have been told that going on an RBC stimulating drug (darbepoetin alfa or epoetin alfa) will help treat my anemia. What side effects can I expect?
- What is the optimal level of iron during epoetin alfa (EPO) and darbepoetin alfa (DARB) treatment?
