Necessary Expansion of IVIG Treatment under Medicare
This firm represents the transplant surgeons at the Indiana University Hospital and the surgeons desire that a particular Medicare contractor expand its coverage of intravenous immunoglobulin (IVIG) treatment.
Wisconsin Physicians Service Insurance Corporation (WPS) is a Medicare Administrative Contractor (MAC) for Jurisdiction 5 and Jurisdiction 8 (Iowa, Kansas, Missouri, Nebraska, Indiana and Michigan), as well as a Legacy Medicare Part B contractor for Wisconsin, Illinois, and Minnesota. According to its website, WPS “serves more than 175,000 providers and 9.5 million Medicare beneficiaries” and “processes more than 160 million claims with benefit payments of more than $50 billion annually.” However, WPS has decided not to cover IVIG treatment under Medicare for the desensitization of kidney transplant patients. WPS made this decision despite the presence of significant and overwhelming medical evidence that demonstrates IVIG treatment effectively and efficiently ensures that highly sensitized patients can have successful transplants.
Approximately 30% kidney transplant patients require desensitization in order to receive a transplant. Patients may need desensitization because of childbirth, previous transfusions or previous transplants. IVIG treatment has been proven to successfully desensitize such patients, lengthening life spans and reducing systemic medical expenditures.
In light of the persuasive medical evidence, other Medicare contractors have decided to cover IVIG treatment for the desensitization of transplant patients. In local coverage determinations (LCD), National Government Services, Inc., (A47381/LCD 25820), Palmetto GBA (LCD 25820), and Cahaba GBA (LCD 30029) have all codified IVIG as a covered Medicare treatment for the desensitization of transplant patients.
In its LCD 30147, WPS covers IVIG treatment for thirty conditions, however, none apply to highly sensitive transplant patients/recipients. Thus, the goal is to have WPS include the following language, or something similar, in LCD 30147:
Sensitized renal transplant recipients: IVIG and/or plasmapheresis are used in several sequential treatments pre or post transplant to help with patients sensitized to living or cadaveric organ donors. The attempts to modify panel reactive antibody and/or donor specific antibody levels, with prevention and/or treatment of organ rejection.
Besides presenting WPS with medical evidence demonstrating the need to have IVIG treatment for highly-sensitized transplant patients, we were hoping to compile information regarding all the Medicare contractors that cover such treatment. With this knowledge, we will also learn where (geographically) in the country this treatment is covered under Medicare. Unfortunately, this information has been rather difficult to track down and, thus, we are contacting you and your organization for assistance.
In addition to this research, we would like to organize and sponsor an informal gathering/lunch among the professionals and experts to discuss the best approaches for how this treatment can be fully covered under Medicare, and therefore dismantle the piecemeal approach currently plaguing the healthcare system. We aim to develop a strategy to implement on Capitol Hill that will ensure highly sensitized patients have an affordable avenue to receive IVIG treatment.
If you can help with our request or would like to attend the informal gathering as described above, please call Bill Broydrick or Brendan Lowd at 202-637-0637, or feel free to email Bill at email@example.com, or Brendan at firstname.lastname@example.org.
Thank you for your assistance with this matter.