Nesiritide for Treatment of Heart Failure Patients

CMS has issued a national non-coverage determination (effective March 2, 2006) that nesiritide is not reasonable and necessary for the treatment of congestive heart failure (CHF) for Medicare beneficiaries in any setting, and there are no nationally covered indications under this NCD. The policy notes this determination applies only to treatment of CHF and preserves Medicare Administrative Contractor discretion regarding other off-label uses or uses consistent with the FDA intravenous indication for acutely decompensated CHF with dyspnea at rest or with minimal activity (see manual review note).

"There are no nationally covered indications for nesiritide under this NCD."

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