Therapeutic Membrane Plasmapheresis

 

Insurance Coverage for Plasmapheresis

 

This is a brief overview of Medicare's 2006 coverage for plasmapheresis in the hospital outpatient setting. In general, this is also applicable to other health insurance policies.

Below is a cost summation for a five-day treatment with plasmapheresis.

 

 

In the inpatient setting the payment rate is usually driven by the patient’s principle diagnosis.

Below are some diagnoses for which therapeutic plasma exchange is commonly covered by insurance companies, variously as first-line therapy, adjunctive therapy, or as “last resort” or salvage therapy:

Guillain-Barre syndrome
Lambert-Eaton myasthenic syndrome
Myasthenia gravis
Macroglobulinemia (Waldenstrom’s)
Glomerulonephritis with anti-glomerular BM antibodies
Rapidly progressive glomerulonepritis
CIDP
Secondary thrombocytopenia; post-transfusion purpura (PTP)
Sydenham’s chorea
Thrombotic thrombocytopenic purpura (TTP)
Other paraproteinemias (cryoglobulinmia)
Systemic lupus erythematosis

Medicare’s Indications and Limitation of Coverage. Apheresis is covered for the following indications:

• Plasma exchange for acquired myasthenia gravis;
• Leukapheresis in treatment of leukemia;
• Plasmapheresis in the treatment of primary macroglobulinemia (Waldenstrom)
• Treatment of hyperglobulinemias, including (but not limited to) multiple myelomas, cryblobulinemia and hyperviscosity syndromes;
• Plasmapheresis or plasma exchange as a last resort treatment of thrombotic thrombocytopenic purpura (TTP)
• Plasmapheresis or PE in the last resort treatment of life threatening rheumatoid vasculitis;
• Plasma perfusion of charcoal filters for treatment of pruritis of cholestatic liver disease;
• Plasma exchange in the treatment of Goodpasture’s Syndrome;
• Plasma exchange in the treatment of glomerulonephritis associated with antiglomerular basement membrane antibodies and advancing renal failure or pulmonary hemorrhage;
• Treatment of chronic relapsing polyneuropathy for patients with severe or life threatening symptoms who have failed to respond to conventional therapy;
• Treatment of Guillain-Barre Syndrome; and
• Treatment of last resort for life threatening systemic lupus erythematosus (SLE) when conventional therapy has failed to prevent clinical deterioration

 

Sources:
American Society for Apheresis. Therapeutic Apheresis: A Guide to Billing and Securing Appropriate Reimbursement 2006 Edition

Nagpal S et al. Treatment of Guillain-Barré Syndrome: A Cost-Effectiveness Analysis. Journal of Clinical Apheresis 1999; 14.