medcare coverage for provenge

Not sure if posted before, maybe relevent to future of PRR RE-dnd
:-

Dendreon Announces the Centers for Medicare and Medicaid Services (CMS) Will Now Cover Infusion Costs Associated with the Administration of PROVENGE

From the PharmaLive.com News Archive - Nov. 21, 2011
CMS Updates Coverage Policy to Reimburse for Costs Associated with the Infusion

SEATTLE--(BUSINESS WIRE)--Nov 21, 2011 - Dendreon Corporation (NASDAQ:DNDN) today announced the Centers for Medicare and Medicaid Services (CMS) updated their coverage policy to now cover the infusion costs associated with the administration of PROVENGE® (sipuleucel-T). With this decision, the coverage of PROVENGE is now consistent with all other infused biologics.

CMS has issued two new transmittals that instruct the local Medicare Administrative Contractors (MACs) that the costs associated with administering PROVENGE will now be covered and can be billed separately. Additionally, the CMS decision will retroactively cover claims for costs associated with the administration of PROVENGE effective for dates of service on or after June 30, 2011, allowing physicians to collect for all previous infusions.

CMS issued a final National Coverage Decision (NCD) for PROVENGE on June 30, 2011, requiring Medicare contractors to cover the use of PROVENGE for treatment of asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory) prostate cancer. The NCD standardized coverage processes across the country for all Medicare patients with asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory) prostate cancer and provided the local Medicare Administrative Contractors (MACs) specific criteria, consistent with the label, on how PROVENGE should be covered.

Since the issuance of the final NCD and the activation of a PROVENGE specific Q-code, which accelerates electronic adjudication of claims, the reported average time to payment for physicians is approximately 30 days.

Physicians with questions regarding securing payment related to past PROVENGE infusions can contact the PROVENGE call center, Dendreon ON Call, at 1-877-336-3736 for additional information.