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PROGRAM MEMORANDUM. INTERMEDIARIES/CARRIERS. Department of Health and Human Services. Health Care Financing Administration . Transmittal No. AB-98- 34 Date JULY 1998. Change Request #555. SUBJECT:Modification of Medicare Policy for Erythropoietin (EPO) http://www.hcfa.gov/pubforms/transmit/r5ch34p2.htm
When indicated, conduct post-payment review of EPO by looking at a 90-day rolling average of hematocrit levels. Because of the natural variability in hematocrit levels and because we are encouraging practitioners to maintain a hematocrit level within the range of 33 to 36 percent as recommended by the Dialysis Outcomes Quality Initiative, use a threshold hematocrit value of 37.5 percent in targeting aberrant cases. Identify practitioners with an atypical number of patients with hematocrit levels above a 90-day rolling average of 37.5 percent for routine medical review activities, such as educational efforts or pre-payment reviews.