Nesiritide for Treatment of Heart Failure Patients
The Centers for Medicare & Medicaid Services (CMS)
has determined that there is insufficient evidence to conclude that the use of Nesiritide for
the treatment of chronic heart failure is reasonable and necessary for Medicare
beneficiaries. Effective for dates of service on or after March 2, 2006, CMS will deny
coverage of Nesiritide for the treatment of chronic heart failure in Medicare beneficiaries.
CMS has determined that all other indications for the use of Nesiritide not otherwise
indicated as non-covered above are left to local contractor discretion. (This addition to
200.1, of Pub. 100-03 is a national coverage determination (NCD) made under section
1862(a)(1) of the Social Security Act. NCDs are binding on all carriers, fiscal
intermediaries, quality improvement organizations, health maintenance organizations,
competitive medical plans, health care prepayment plans, the Medicare Appeals Council,
and administrative law judges (see 42 CFR 405.1064, effective May 1, 2005). An NCD
that expands coverage is also binding on a Medicare advantage organization. In addition,
an administrative law judge may not review an NCD. (See 1869(f)(1)(A)(i) of the Social
Security Act.)
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: April 07, 2006
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.