Nesiritide for Treatment of Heart Failure Patients Form
Procedure is not covered
Background for this Policy
A. General
Nesiritide (Natrecor®) is Food and Drug Administration (FDA)-approved for the intravenous treatment of patients with acutely decompensated congestive heart failure (CHF) who have dyspnea (shortness of breath) at rest or with minimal activity. Nesiritide is not self-administered.
B. Nationally Covered Indications
N/A
C. Nationally Non-Covered Indications
Effective for dates of service on or after March 2, 2006, the Centers for Medicare & Medicaid Services has determined that there is sufficient evidence to conclude that the use of Nesiritide for the treatment of CHF is not reasonable and necessary for Medicare beneficiaries in any setting.
D. Other
Effective for dates of service on or after March 2, 2006, this determination applies only to the treatment of CHF and does not change Medicare Administrative Contractor discretion to cover other off-label uses of Nesiritide or use consistent with the current FDA indication for intravenous treatment of patients with acutely decompensated CHF who have dyspnea at rest or with minimal activity.
Walk through this policy with us
Review how this policy can be converted into cited criteria, prior authorization checks, and operational automation.