Straight from the Medicare Benefits Policy Manual for HH concerning Vit B12: 1. Vitamin B-12 injections are considered specific therapy only for the following conditions: Specified anemias: pernicious anemia, megaloblastic anemias, macrocytic anemias, fish tapeworm anemia; Specified gastrointestinal disorders: gastrectomy, malabsorption syndromes such as sprue and idiopathic steatorrhea, surgical and mechanical disorders such as resection of the small intestine, strictures, anastomosis and blind loop syndrome, and Certain neuropathies: posterolateral sclerosis, other neuropathies associated with pernicious anemia, during the acute phase or acute exacerbation of a neuropathy due to malnutrition and alcoholism. For a patient with pernicious anemia caused by a B-12 deficiency, intramuscular or subcutaneous injection of vitamin B-12 at a dose of from 100 to 1000 micrograms no more frequently than once monthly is the accepted reasonable and necessary dosage schedule for maintenance treatment. More frequent injections would be appropriate in the initial or acute phaseof the disease until it has been determined through laboratory tests that the patient can be sustained on a maintenance dose.
Nancy Wolverton RN, CCM, HCS-D Kindred at Home Little Rock, Arkansas 501-508-8526 Nancy.Wolverton@kindred.com
Hello Lisa. In regards to Vit B12 injection and coverage under Medicare HH benefits, the beneficiary of course must meet the homebound criteria and there must be no regular way for this patient to get to the doctor to get the monthly injection, and no one willing or able to administer at home. Each note must reflect this. The medical case must be one that the patient cannot absorb vit b12 if taken orally. Vit b12 deficiency is not a covered condition as all one needs to do is take vit b12 orally to correct the deficiency. On the other hand, pernicious anemia is a qualifying condition in which intrinsic factor in the body which is necessary to absorb vit B12 from the gut is absent. Without it, one cannot absorb B12 and will stay anemic until b12 is given per IM.
Nancy Wolverton RN, CCM, HCS-D Kindred at Home Little Rock, Arkansas 501-508-8526 Nancy.Wolverton@kindred.com
Thank you Nancy!! I figured as much as this is not the first time this has been questioned however having a second voice sometimes helps when pleading one's case Appreciate your time!
Comments
1. Vitamin B-12 injections are considered specific therapy only for the following conditions:
Specified anemias: pernicious anemia, megaloblastic anemias, macrocytic anemias, fish tapeworm anemia;
Specified gastrointestinal disorders: gastrectomy, malabsorption syndromes such as sprue and idiopathic steatorrhea, surgical and mechanical disorders such as resection of the small intestine, strictures, anastomosis and blind loop syndrome, and
Certain neuropathies: posterolateral sclerosis, other neuropathies associated with pernicious anemia, during the acute phase or acute exacerbation of a neuropathy due to malnutrition and alcoholism.
For a patient with pernicious anemia caused by a B-12 deficiency, intramuscular or subcutaneous injection of vitamin B-12 at a dose of from 100 to 1000 micrograms no more frequently than once monthly is the accepted reasonable and necessary dosage schedule for maintenance treatment. More frequent injections would be appropriate in the initial or acute phaseof the disease until it has been determined through laboratory tests that the patient can be sustained on a maintenance dose.
Nancy Wolverton RN, CCM, HCS-D
Kindred at Home
Little Rock, Arkansas
501-508-8526
Nancy.Wolverton@kindred.com
In regards to Vit B12 injection and coverage under Medicare HH benefits, the beneficiary of course must meet the homebound criteria and there must be no regular way for this patient to get to the doctor to get the monthly injection, and no one willing or able to administer at home.
Each note must reflect this. The medical case must be one that the patient cannot absorb vit b12 if taken orally.
Vit b12 deficiency is not a covered condition as all one needs to do is take vit b12 orally to correct the deficiency.
On the other hand, pernicious anemia is a qualifying condition in which intrinsic factor in the body which is necessary to absorb vit B12 from the gut is absent. Without it, one cannot absorb B12 and will stay anemic until b12 is given per IM.
Nancy Wolverton RN, CCM, HCS-D
Kindred at Home
Little Rock, Arkansas
501-508-8526
Nancy.Wolverton@kindred.com