Therapeutic Apheresis for Familial Hypercholesterolemia

Noridian covers plasma apheresis for refractory familial hypercholesterolemia in functional homozygotes (LDL > 500 mg/dL) and in functional heterozygotes with LDL thresholds > 300 mg/dL (no CVD) or > 200 mg/dL (with CVD) when resistant to appropriate lifestyle changes and maximal statin therapy with or without ezetimibe. Coverage is also allowed in pregnancy when usual therapy is inadequate for uteroplacental perfusion; all claims must be supported by signed, dated clinical documentation of prior therapies and lifestyle measures and are subject to pre- or post-payment review under NCD 110.14 and contractor discretion.

"Plasma apheresis is covered for functional homozygotes with familial hypercholesterolemia who have an LDL cholesterol > 500 mg/dL and who remain refractory to appropriate lifestyle changes and maxi..."

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