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April 13, 2012

Rituximab Update

Effective 01 May 2012 CGS will allow the use of rituximab in Medicare beneficiaries who have end stage renal disease and are candidates for renal transplant yet have a high level of anti-HLA antibodies. Based on the currently available evidence based scientific literature rituximab should normally be used in conjunction with IVIG. While plasmapheresis is also normally used the use of plasmapheresis is left to the physician's professional judgment.

The claims shall have ICD-9 585.6 affixed to allow payment. Claims may be selected at will by CGS for review to assure that medical necessity has been met based on the clinical record documentation.

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