Hematology reimbursement alerts

MIMRYLO (rusfertide acetate) received FDA approval on August 28, 2026, as a new molecular entity with orphan drug designation, but the billing pathway cannot be determined until the FDA label publishe

Empaveli (pegcetacoplan) was approved May 14, 2021 as a subcutaneous solution for a rare condition under orphan drug designation, billing under Medicare Part B. As a subcutaneous injectable administer

Zenbexus (iberdomide) was approved as an oral capsule, placing it squarely in the Medicare Part D billing pathway as a self-administered drug dispensed through retail or specialty pharmacy. As an orph

Injectafer (ferric carboxymaltose) is an intravenous iron replacement therapy approved for iron deficiency anemia, administered via intravenous infusion and billed under Medicare Part B. This Type 5 s

Argatroban is an intravenous anticoagulant with an established Part B billing pathway, administered in inpatient and outpatient hospital settings. This approval (NDA212035) is a Type 5 submission repr

Lynozyfic (linvoseltamab-gcpt), a newly approved injectable biologic for an orphan indication, will be billed under Medicare Part B given its injection route of administration. As a new molecular enti

Revlimid (lenalidomide) is an oral capsule approved under priority review as a thalidomide analog, billing through Medicare Part D as a self-administered outpatient drug. As an oral oncology agent, it

Vonjo (pacritinib) is an oral capsule approved for myelofibrosis, billing through Medicare Part D as a self-administered drug. As an orphan drug kinase inhibitor with no existing J-code, it does not f

Jakafi (ruxolitinib) is an oral tablet approved as a New Molecular Entity for a rare condition, placing it squarely in the Medicare Part D billing pathway as a self-administered drug dispensed through

Ojjaara (momelotinib), approved September 15, 2023 as an oral tablet, follows a Part D billing pathway as a self-administered drug dispensed through retail or specialty pharmacy. As an orphan drug and

Jakafi XR (ruxolitinib) is an oral extended-release tablet approved under NDA217180, billing through Medicare Part D as a self-administered drug. As a new formulation of an existing kinase inhibitor w

Inrebic (fedratinib hydrochloride) is an oral capsule approved for myelofibrosis, billing under Medicare Part D as a self-administered drug. As an orphan drug with priority review, it is likely a high

Fabhalta (iptacopan), an oral capsule approved for a rare condition under orphan drug designation, follows a Part D billing pathway as a self-administered oral medication. Billing teams should confirm

Stimate (desmopressin acetate) nasal spray, approved in 1994 as a new dosage form for a rare bleeding disorder indication, is administered intranasally and follows a Part D billing pathway as a self-a

Argatroban (Fresenius Kabi USA, NDA201811) is an injectable anticoagulant approved as a new formulation/manufacturer submission, administered via intravenous injection and billed under Medicare Part B

Sarclisa Escena (isatuximab-irfc) was approved as a new subcutaneous dosage form of the existing IV CD38-directed antibody isatuximab, indicated for multiple myeloma under orphan drug designation. As

BKEMV (eculizumab-aeeb) is an injectable biosimilar complement inhibitor approved via BLA761333, following the reference product Soliris (eculizumab). As an intravenous injectable, it follows the Part

Argatroban in 0.9% Sodium Chloride (NDA206769) is a new intravenous formulation of the established direct thrombin inhibitor argatroban, approved via a Type 5 submission by Teva Pharmaceuticals. As an

Sarclisa (isatuximab) is an injectable CD38-directed cytolytic antibody approved for multiple myeloma, administered via intravenous injection and billing under Medicare Part B. As a hospital or office

Besremi (ropeginterferon alfa-2b) is a subcutaneously administered injectable approved for polycythemia vera, supporting a Part B billing pathway as a physician-administered drug. As an orphan drug in

The recent FDA approval of Argatroban as an injectable drug suggests it will likely be assigned a J-code for billing under Medicare Part B. Since it is an anticoagulant, providers may receive pass-thr

Argatroban in dextrose is an injectable medication that is likely to receive a J-code assignment for Medicare billing. Since it falls under Part B, billing may involve ASP+6% reimbursement if it meets

The proposed LCD for Non-Next Generation Sequencing Tests could limit coverage for certain diagnostic tests in evaluating BCR-ABL negative myeloproliferative neoplasms. Facilities may see a decrease i

The proposed LCD on non-next generation sequencing tests for diagnosing BCR-ABL negative myeloproliferative neoplasms may lead to changes in reimbursement policies and coverage determinations, impacti

The proposed LCD could significantly impact billing practices for non-next generation sequencing tests used in diagnosing BCR-ABL negative myeloproliferative neoplasms. It may lead to a more stringent

The proposed LCD on genetic testing for hereditary thrombophilia could influence billing practices related to genetic testing claims. Providers may need to ensure compliance with the new guidelines to

The proposed Local Coverage Determination (LCD) for genetic testing related to hereditary thrombophilia could significantly impact claims processing and reimbursement rates for genetic tests in this a

The proposed Local Coverage Determination (LCD) for genetic testing related to hereditary thrombophilia requires billing team review

The proposed LCD on genetic testing for hereditary thrombophilia could lead to enhanced coverage for specific tests, impacting the way providers bill for related services. This may increase the number

The proposed LCD for Erythropoiesis Stimulating Agents may significantly influence billing practices for providers utilizing these treatments. Depending on the final decision, there could be changes t

The LCD outlines coverage for non-next generation sequencing tests for diagnosing BCR-ABL negative myeloproliferative neoplasms, which may significantly influence reimbursement policies. Providers wil

The new LCD on Non-Next Generation Sequencing Tests for BCR-ABL Negative Myeloproliferative Neoplasms could lead to supports compliance with updated rates for these tests. This may impact reimbursement rates a

With the new LCD regarding non-next generation sequencing tests for diagnosing BCR-ABL negative myeloproliferative neoplasms effective from August 17, 2025, providers must ensure adjustments are made

The implementation of this new LCD on genetic testing for hypercoagulability may create billing complexities for providers. It emphasizes the need for proper documentation and ICD-10 coding to ensure

The implementation of the MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease LCD may impact the billing processes for providers, particularly in the areas of documentation and codi

The implementation of this Local Coverage Determination (LCD) by Noridian may affect the billing process for genetic testing related to BCR-ABL negative myeloproliferative disease. Providers should en

The new LCD for genetic testing of BCR-ABL negative myeloproliferative disease will impact billing by establishing specific criteria for coverage, thereby influencing reimbursement rates and patient a

The recent LCD from Palmetto GBA affects billing for genetic testing related to BCR-ABL Negative Myeloproliferative Disease. Providers must ensure compliance with the updated guidelines to avoid claim

The new LCD for genetic testing related to BCR-ABL negative myeloproliferative disease will clarify billing procedures and permissible tests. It is crucial for claims to align with the specified crite

The introduction of the new LCD for genetic testing related to hypercoagulability may have significant billing implications for providers. It will be essential for practices to verify patient eligibil

The new MolDX guidelines for genetic testing related to hypercoagulability and thrombophilia will require careful attention to billing compliance. This may lead to an supports compliance with updated rates inquiries rel

The introduction of LCD for non-next generation sequencing tests will impact the billing process for myeloproliferative neoplasms diagnosis, necessitating updates to coding practices. Providers must e

The implementation of the LCD for non-next generation sequencing tests for diagnosing BCR-ABL negative myeloproliferative neoplasms requires billing team review

The coverage policy for allogeneic hematopoietic cell transplantation in treating primary refractory or relapsed Hodgkin's and Non-Hodgkin's lymphomas may significantly impact billing practices, as th

The upcoming LCD for Immune Globulin Intravenous (IVIg) may lead to changes in billing practices and reimbursement rates for providers. It is essential for healthcare professionals to prepare for pote

The new LCD will impact billing for allogeneic hematopoietic cell transplantation procedures in patients with primary refractory or relapsed lymphoma. Providers should ensure proper coding and documen

The introduction of new LCD for Erythropoiesis Stimulating Agents may impact billing procedures due to the specific guidelines outlined by CGS. Providers need to ensure that their documentation suppor

The recent LCD from Noridian for Allogeneic Hematopoietic Cell Transplantation will likely impact billing for providers treating patients with refractory or relapsed Hodgkin's and Non-Hodgkin's Lympho

The new LCD for Immune Thrombocytopenia (ITP) therapy set to take effect on March 5, 2026, will impact billing practices for related services. Providers will need to review and adjust their coding and

The effective date of the LCD for Intravenous Immune Globulin may affect billing practices as it introduces new criteria for reimbursement. Providers will need to be aware of updated documentation and