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WPS’ Response to the Advocacy Council

| | April 29, 2016

WPS’ Response to the Advocacy Council

From: Noel, Ella
Sent: Wednesday, April 27, 2016 9:00 AM

Dear Dr. Meadows:

WPS GHA has decided to make further changes in the LCD on Immunotherapy after further review of the rules and regulations and clarification from CMS after your request for reconsideration of LCD L36408.  These changes will be posted on our website on June 1, 2016.  The section, Providers of Immunotherapy, will now read as follows:

Providers of Immunotherapy:
The physician prescribing immunotherapy should be trained and experienced in prescribing and administering immunotherapy. For those providers without formal training moving into an allergy type practice, ongoing yearly training specifically for allergy testing and treatment should be evident in CMEs. If any Medicare entity requests documentation of training, formal training or ongoing CME updates, this information must be made available.

Antigens need to be prepared by a physician who is a doctor of medicine or osteopathy who has examined the patient and has determined a plan of treatment and a dosage regimen. (CMS Pub 100-02 Medicare Benefit Policy Manual, Chapter 15, Section 50.4.4.1)

Antigens must be administered in accordance with the plan of treatment and by a doctor of medicine or osteopathy or by a properly instructed person (who could be the patient) under the supervision of the doctor.

WPS GHA would continue to expect compliance with CMS Pub 100-02 Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services Sections, Section 60.2 – Services of Nonphysician Personnel Furnished Incident to Physician’s Services.

“A nonphysician practitioner such as a physician assistant or a nurse practitioner may be licensed under State law to perform a specific medical procedure and may be able (see §§190 or 200, respectively) to perform the procedure without physician supervision and have the service separately covered and paid for by Medicare as a physician assistant’s or nurse practitioner’s service. However, in order to have that same service covered as incident to the services of a physician, it must be performed under the direct supervision of the physician as an integral part of the physician’s personal in-office service. As explained in §60.1, this does not mean that each occasion of an incidental service performed by a nonphysician practitioner must always be the occasion of a service actually rendered by the physician. It does mean that there must have been a direct, personal, professional service furnished by the physician to initiate the course of treatment of which the service being performed by the nonphysician practitioner is an incidental part, and there must be subsequent services by the physician of a frequency that reflects the physician’s continuing active participation in and management of the course of treatment. In addition, the physician must be physically present in the same office suite and be immediately available to render assistance if that becomes necessary.”

Ella M. Noel, DO, FACOI
J8 Contractor Medical Director, Medicare
WPS Government Health Administrators
P.O. Box 1787
1717 W. Broadway
Madison, WI   53701-1787
e: Ella.Noel@wpsic.com

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