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Drug Articles Added to “Coverage of Drugs for Labeled and Off-Labeled Indications” LCD

Note: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material which is copyrighted by the American Medical Association (AMA). You are forbidden to download the files unless you read, agree to and abide by the provisions of the copyright statement. Read the copyright statement now (you will be linked back to here).

Effective November 17, 2006, Empire Medicare Services New York and New Jersey will add the articles listed below to their LCDs for Coverage of Drugs for Labeled and Off-Labeled Indications. The articles can be found on the CMS Coverage Database, or can be accessed by clicking on the links at the end of the LCD (L7497- NY, L3614- NJ) on Empire’s Web site. These articles define current coverage by Empire Medicare Services. Some include coverage that has been updated since the articles were originally published. The articles will continue to be updated in the event of changes in labeling for each drug, or if off-label use is approved by the carrier. Please refer to the LCD for complete information on gaining off-label approval and accessing the articles.

 

DRUG NAME NY ARTICLE NUMBER NJ ARTICLE NUMBER

octreotide (Sandostatin LAR® Depot)

A41255

A41255

azacitidine (Vidaza™)

A26188

A26188

aminolevulinic acid HCl (Levulan® Kerastick)

A10728

A12046

omalizumab (XolAir®)

A42882

A19221

trastuzumab (Herceptin ®)

A1536

A42885

arsenic trioxide (Trisenox™)

A10199

A12062

denileukin diftitox (Ontak®)

A42830

A12368

epirubicin (Ellence®)

A41195

A42844

abarelix (Plenaxis™)

A42828

A26177

alemtuzumab (Campath®)

A41222

A41223

 

Posted: 11/15/2006

CPT codes, descriptions, and other data only are copyright 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.

 

 

   
 
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