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MIR-2007-5AB, May 2007
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Blood Brain Barrier Osmotic Disruption for Treatment of Brain Tumors
Provider Types Affected
Physicians and providers submitting claims to Medicare contractors, fiscal intermediaries (FI), Part Medicare Administrative Contractors (MAC), and carriers.
What Providers Need to Know
Effective for claims with dates of service on or after March 20, 2007, the use of osmotic blood brain barrier disruption is not considered reasonable and necessary when it is used as part of a treatment regimen for brain tumors in Medicare patients.
Background
This article and Change Request (CR) 5530 states that Medicare does not currently have a national coverage determination (NCD) for osmotic blood brain barrier disruption (BBBD) as part of a treatment regimen for brain tumors. The Centers for Medicare & Medicaid Services (CMS) accepted a formal request for noncoverage of BBBD used for this indication.
CMS determined that the use of osmotic blood brain barrier disruption is not reasonable and necessary when it is used as part of a treatment regimen for brain tumors.
Be aware that the BBBD process includes all items and services necessary to perform the procedure, including hospitalization, monitoring, and repeated imaging procedures.
This NCD does not alter in any manner the coverage of anti-cancer chemotherapy.
Additional Information
If you have questions, please contact your Medicare FI, carrier, or MAC at their toll-free number which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  on the CMS Web site.
CR5530 is the official instruction issued to your Medicare FI, carrier, or MAC. That instruction may be viewed by going to http://www.cms.hhs.gov/Transmittals/downloads/R67NCD.pdf  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM5530
Pub. 100-3, Transmittal# R67NCD, CR# 5530
Related CR Release Date: April 6, 2007
Effective Date: March 20, 2007
Implementation Date: May 7, 2007
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