Page 76 - Medicare Benefit Policy Manual

• It is self-administered in the home by any dialysis patient (or patient caregiver)
who is determined competent to use the drug and meets the other conditions
detailed below.

NOTE: Payment may not be made for EPO under the incident to provision when EPO is
administered in the renal dialysis facility.

Also, in the office setting, reimbursement will be made for the administration charge only
for non-ESRD patients receiving EPO.

50.5.2.1 - Requirements for Medicare Coverage for EPO
(Rev. 1, 10-01-03)
B3-2049.5

Medicare covers EPO and items related to its administration for dialysis patients who use
EPO in the home when the following conditions are met:

A. Patient Care Plan

A dialysis patient who uses EPO in the home must have a current care plan (a copy of
which must be maintained by the designated backup facility for Method II patients) for
monitoring home use of EPO that includes the following:

1. Review of diet and fluid intake for aberrations as indicated by hyperkalemia and
elevated blood pressure secondary to volume overload;

2. Review of medications to ensure adequate provision of supplemental iron;

3. Ongoing evaluations of hematocrit and iron stores;

4. Reevaluation of the dialysis prescription taking into account the patient’s
increased appetite and red blood cell volume;

5. Method for physician and facility (including backup facility for Method II
patients) follow-up on blood tests and a mechanism (such as a patient log) for
keeping the physician informed of the results;

6. Training of the patient to identify the signs and symptoms of hypotension and
hypertension; and

7. The decrease or discontinuance of EPO if hypertension is uncontrollable.

B. Patient Selection