National Coverage Determinations
Posted on November 27, 2019
As a Medicare health plan, Health New England Medicare Advantage covers all services required by Original Medicare. We only make mid-year benefit changes when Medicare changes its coverage rules. When this happens, Medicare issues a National Coverage Determination (NCD) explaining whether Medicare will pay for an item or service. Below are the recent changes from the past year:
Ambulatory Blood Pressure Monitoring – Effective July 2, 2019
The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension in Medicare beneficiaries under the following circumstances:
1) For beneficiaries with suspected white coat hypertension.
2) For beneficiaries with suspected masked hypertension. (Read more at: https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=294)
Chimeric Antigen Receptor (CAR) T-cell Therapy for Cancers – Effective August 7, 2019
The Centers for Medicare & Medicaid Services (CMS) covers autologous treatment for cancer with T-cells expressing at least one chimeric antigen receptor (CAR) when administered at healthcare facilities enrolled in the FDA risk evaluation and mitigation strategies (REMS) and used for a medically accepted indication as defined at Social Security Act section 1861(t)(2). (Read more at: https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=291)
You can also find a listing of recent NCDs on our website at healthnewengland.org/medicare/members.
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