January 31, 2001

Medi-909-01

TO: ALL MEDICARE PROVIDERS

SUBJECT: IMMUNOSUPPRESSIVE DRUGS

PRIMARY INTERESTS: BUSINESS OFFICE MANAGERS, MEDICAL DIRECTORS

EFFECTIVE DATE: DECEMBER 21, 2000

Attached is a copy of the Health Care Financing Administration's Program Memorandum AB-01-10 which deals with immunosuppressive drugs.

THIS BULLETIN SHOULD BE SHARED WITH ALL HEALTH CARE PRACTITIONERS AND MANAGERIAL MEMBERS OF THE PROVIDER STAFF. NO COST COPIES ARE ALSO AVAILABLE FROM OUR WEB SITE AT riverbendgba.com

Please refer any questions to our office toll free at 877-296-6189.

This Program Memorandum (PM) implements §113 of the Benefits Improvement and Protection Act of 2000 by eliminating the time limit for coverage of immunosuppressive drugs under the Medicare program.

Effective with immunosuppressive drugs furnished on or after December 21, 2000, there is no longer any time limit for Medicare benefits. This PM supersedes PM AB-99-98, which described the method for determining the former time limit for this benefit that applied to drugs furnished prior to December 21, 2000. This policy applies to all Medicare entitled beneficiaries who meet all of the other program requirements for coverage under this benefit. Therefore, for example, currently entitled beneficiaries who had been receiving benefits for immunosuppressive drugs in the past, but whose immunosuppressive drug benefit was terminated solely because of the time limit described in PM AB-99-98, would now resume receiving that benefit for immunosuppressive drugs furnished on or after December 21, 2000.

Timely claims processing rules apply.

These claims processing instructions are divided into two areas – claims submitted before April 1, 2001, and claims submitted on or after April 1, 2001.

Claims submitted before April 1, 2001 -- The Common Working File (CWF) system change will be made April 1, 2001. In the interim, intermediaries must suspend claims for immunosuppressive drugs that are rejected by CWF with error code 28X1 and the date of service on the claim is December 21, 2000, or after. In the interim, DMERCs must suspend these denied claims within your system when the date of service on the claim is December 21, 2000, or after. Release for claims processing on April 1, 2001. Interest will be paid on these claims when applicable

Do not search for previously adjudicated claims. However, reopen and reprocess claims brought to your attention in accordance with this instruction.

For claims with dates of service on or after December 21, 2000, you no longer need to suspend claims, they will be paid through the normal claims process.

DMERCs Immunosuppressive Drug Reports will not be required on/after April 1, 2001.

Contractors must publish this expanded coverage information in their next regularly scheduled bulletins, include this information on web sites and in routine training sessions.