Slide 26 of 50
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
HCFA is developing a national policy for Medicare exceptions justifying a target hematocrit greater than 33 to 36 percent. In the interim, upon post-payment review if the treating physician argues it is medically necessary to have a target hematocrit that is greater than 36 percent, then the medical justification must be fully documented and satisfy the judgement of the carrier.