Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Studies with JAK inhibitors are presently ongoing. The total effective rate in the combination group was 85.0 % (17/20) which was better than 75.0 % (15/20) in the WM group (p < 0.05). This trial was stopped early after enrolment and follow-up of 133 children because of analysis showing futility in reaching the composite primary end-point. Porphyria cutanea tarda. Bacon BR, Adams PC, Kowdley KV, et al, American Association for the Study of Liver Diseases. Omaha, NE: eMedicine.com; updated August 11, 2002. Omaha, NE: eMedicine.com; updated April 8, 2002. 2019;2019:8650398. Barton JC, Lee PL, West C, Bottomley SS. These investigators will include RCTs assessing BL for the common cold. Expert Rev Anticancer Ther. The haematological management of patients with cyanotic congenital heart disease. Treatment of acute gouty arthritis by blood-letting cupping plus herbal medicine. During your therapeutic phlebotomy procedure, a nurse will use a needle connected to a blood collection bag to draw a certain amount of your blood. background-position: right 65%; is therapeutic phlebotomy covered by insurance. In a review on evidence-based approach for the treatment of adults with sickle cell disease, Lottenberg and Hassell (2005) noted that reports and case series indicated that repeated phlebotomy to lower the hemoglobin (Hb) level and induce iron deficiency can reduce the frequency of painful episodes in selected patients with high steady state Hb levels. These investigators stated that therapeutic phlebotomy was feasible and effective, and would prevent complications of iron overload. During the study period, the annual numbers of hospitalization days were respectively 20, 5,6 and 1. Their therapeutic effects were observed. The JAK2V617F mutation, a point mutation in the tyrosine kinase gene JAK2 (Janus Kinase 2), has emerged as a central feature in the pathogenesis of MPN. It is used mainly to reduce blood volume, red cell mass and iron stores. Weisse AB, Moschos CB, Frank MJ, et al. Response rate, recurrence rate, and adverse events (AEs) were assessed as secondary outcomes. Fowler C. Hereditary hemochromatosis: Pathophysiology, diagnosis, and management. 2009;29(9):711-713. Zhongguo Zhen Jiu. Int J Clin Pract. color: white; Sampietro M, Fiorelli G, Fargion S. Iron overload in porphyria cutanea tarda. The authors concluded that the clinical phenotypes and hemochromatosis genotypes of adults who developed iron overload after ingesting iron supplements over long periods were heterogeneous. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Dual therapy with hydroxyurea and phlebotomy may be an effective approach to patients with HbSC that do not experience improvement with hydroxyurea alone. For example, iron, when added to media containing urate crystals, stimulated oxidative stress with subsequent complement and neutrophil activation. Subsequently, the identification of several other mutated genes in MPN has shown that the pathogenesis is complex and that the JAK2V617F mutation is a critical, but not the only step leading to the uncontrolled proliferation in MPN including PV. Accessed November 12, 2002. Am J Gastroenterol. Thus, this disorder requires an aggressive therapeutic approach to achieve iron depletion. Overview of hypertension in adults. Transfusion. Moreover, they stated that ongoing multi-center trials are investigating the use of chronic transfusion to prevent silent infarcts, the use of hydroxyurea as an alternative to transfusion in children with abnormal transcranial Doppler ultrasonography velocities, and the use of hydroxyurea to prevent conversion of transcranial Doppler ultrasonography velocities from conditional (borderline) to abnormal values. Two RCTs specifically included only patients with either high ferritin or high hepatic iron content. A total of 7 RCTs with 637 hypertensive patients from 1989 to 2017 were identified. If it increases above the upper limit of normal, a cause should be sought, and if none is found, the dose of testosterone should be decreased or stopped. A phlebotomy performed for therapeutic purposes is an eligible procedure and should be reported under code 99195 (phlebotomy, therapeutic). For patients at high risk for thrombosis (i.e., age of greater than 60, prior thrombosis), we recommend that treatment with phlebotomy be supplemented with the use of a myelosuppressive agent. Typically, therapeutic phlebotomy consists of. Statistical analysis was performed using Comprehensive Meta-Analysis version 2.0. In contrast, the risk of thrombosis exceeds 20 %. Treatment of resistant hypertension. Toronto, ON: CACHNET; 2002. Pediatr Transplant. Therapeutic Phlebotomy is the removal of whole blood from a patient, usually to lower the blood count, as in patients with Polycythemia or Red Cell Hyperplasia, or to remove excess iron, as in Hemochromatosis or Porphyria patients. margin-top: 38px; . Accessed November 12, 2002. Medicare only covers three. Seventy-six percent of respondents reported full or partial insurance coverage of therapeutic phlebotomy charges. Long-term results using hydroxyurea/phlebotomy for reducing secondary stroke risk in children with sickle cell anemia and iron overload. 2002;56(4):272-278. Therapeutic phlebotomy is currently indicated for the treatment of hemochromatosis, polycythemia vera, porphyria cutanea tarda, sickle cell disease, and NAFLD with hyperferritinemia. Where to go for Therapeutic Phlebotomy As a Polycythemia Vera patient, you can not give blood to the Red Cross. The correlation between symptoms and hematocrit levels supports the importance of blood viscosity in contributing to this patient's symptoms. The comprehensive outcomes, which combine the clinical symptoms, signs, and laboratory examinations as one outcome, were not internationally recognized and could not reflect the characteristics of interventions. These researchers stated that large-scale, multi-center RCTs with proper outcome measurements and long-term follow-up are needed to provide convincing proof. These findings raised concerns regarding the persistent risk of vascular events in these donors, especially when coupled with the misperception by patients and health care providers that donation has reduced or eliminated the risks of TRT-induced polycythemia. In patients with established iron overload disease, weakness, fatigue, increased hepatic enzyme concentrations, right upper quadrant pain, and hyperpigmentation are often substantially alleviated by therapeutic phlebotomy. Estimated absorption of iron from supplements in patients 1 to 4 was 20.9 %, 1.9 %, 1.1 %, and 0.08 %. Bacon BR, Kwiatkowski JL. UpToDate [online serial]. 1993;87(6):1954-1959. When applied before iron overload becomes severe, this treatment also prevents complications of iron overload, including hepatic cirrhosis, primary liver cancer, diabetes mellitus, hypogonadotrophic hypogonadism, joint disease, and cardiomyopathy. The above policy is based on the following references: Last Review } padding-right: 18px; 2012;18(29):3782-3786. The moxibustion was adopted for 10 days. background-color: #cc0066; Mean Hb concentration was 10.7 g/dL before phlebotomies and 8.8 to 9.2 g/dL during the4 years of treatment. The authors stated that adequately powered RCTs with detailed pre-treatment iron studies should be considered to evaluate phlebotomy as an adjunct to pegylated IFN, with or without ribavirin. OL OL LI { Non-covered Services Certain services are never considered for payment by Medicare. 2013;11:CD003146. Furthermore, an UpToDate review on Approach to the patient with suspected iron overload (Bacon and Kwiatkowski, 2021) states that The major treatments for iron overload include phlebotomy for those without significant anemia, and chelation therapy for those with anemia. 2016;241(7):737-744. The American Association for the Study of Liver Diseases' clinical practice guideline on "Diagnosis and management of hemochromatosis" (Bacon et al, 2011) provided the following recommendations: Barbui and colleagues (2011) presented a review of critical concepts and produced recommendations on the management of Philadelphia-negative classical myeloproliferative neoplasms, including monitoring, response definition, first- and second-line therapy, and therapy for special issues. Arch Pediatr. This list only includes tests, items and services that are covered no matter where you live. The authors concluded that on the basis of diet intervention, electro-acupuncture plus blood-letting puncture and cupping was a better therapy for AGA. Extreme hyper-ferritinemia was detected shortly after transplantation. Iron overload in mild sideroblastic anaemias. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. 2016;7:139-144. /* aetna.com standards styles for templates */ A JAK2 mutation is found in approximately 60 % of patients with ET. 2017;64(1):188-196. Am J Hematol. Therapeutic phlebotomy: A review of diagnoses and treatment considerations. Xiong X-J, Wang P-Q, Li S-J. Searches identified 3 eligible randomized trials (n = 342). Can Fam Physician. However, randomized controlled clinical trials of therapeutic phlebotomy for HCV treatment have not found significant improvements in sustained virologic response with phlebotomy plus interferon (IFN) compared to IFN alone (Fonatana et al, 2000; Di Bisceglie et al, 2000). Prevention of sickle cell crises with multiple phlebotomies. Follow-up with monthly phlebotomies after discharge yielded a favorable outcome with normal transplant functions. This observation promptedthese researchersto identify the potential utility of iron load reduction in the management of this disease. If therapeutic fluid administration is medically necessary (e.g., correction of dehydration, prevention of nephrotoxicity) before or after transfusion or chemotherapy, it may be reported separately. 2006;130(1):225-230. Third, UA over-production from increased de-novo synthesis of purines. Franchini M, Veneri D. Hereditary hemochromatosis. These researchers identified 39 patients on TRT who presented for blood donation over a 2-year period. /*margin-bottom: 43px;*/ These patientshad an Hb level equal to or above 9.5 g/dL. Peto TE, Pippard MJ, Weatherall DJ. .headerBar { In a systematic review and meta-analysis of RCTs, Xiong and colleagues (2019) examined the safety and efficacy of blood-letting therapy (BLT) in the treatment of hypertension. Target levels of phlebotomy should be a ferritin level of 50 to 100 g/L. Serum ferritin and non-transferrin-bound iron also decreased significantly. Rotker et al (2018) stated that a variety of methods for TRT exist, and the major potential risks of TRT have been well established. Recurrent thrombosis in patients with polycythemia vera and essential thrombocythemia: Incidence, risk factors, and effect of treatments. Accessed November 12, 2002. Bouchair et al (2000) reported the findings of sickle cell disease patients who suffered from frequent painful crises and were submitted to phlebotomies in order to reduce hospitalization days due to pain. Yao Q, Zhang X, Mu Y, et al. Rotker KL, Alavian M, Nelson B, et al. An improvement of the clinical and biochemical picture of porphyria cutanea tarda in both patients was obtained with chloroquine therapy given that their chronic anemia did not permit phlebotomy. Waltham, MA: UpToDate; reviewed May 2020. Management of acute and cutaneous porphyrias. ; Writing Committee of the General Haematology Task Force. Diagnosis, management, and differentiation from other hepatic porphyrias. Therapeutic phlebotomy rates varied by sex, age, reason for diagnosis, and severity of symptoms. After treatment, blood UA decreased significantly in the 2 groups (both p < 0.01), the observed group being lower than the control group (p < 0.01). After transplantation of a hemosiderotic liver, it is important to monitor the recipient in terms of iron overload and toxicity. The vast majority of Blue Cross Blue Shield insurance plans cover therapy. (Accessed December 8, 2022) Covered Clinical Diagnostic Laboratory Tests and Services Clinical diagnostic laboratory tests and services are covered when criteria are met. Last updated on 4/2/2021. Blood donation and testosterone replacement therapy. Inati et al (2017) stated that iron overload is well documented in patients with beta-thalassemia major, and patients who have undergone hematopoietic stem cell transplantation (HSCT) remain at risk as a result of pre- and immediate post-HSCT transfusions. The degree of risk must be balanced against the burden of chronic transfusions. Neurophysiological changes were characterized by an increased cortical excitability, including a decrease of motor thresholds and an enhancement of intra-cortical facilitation and cerebello-thalamo-cortical inhibition. Aetna considers therapeutic phlebotomy medically necessary for any of the following indications: Footnote1* Forpersons with hematocrit greater than 60 %. Seventy-six percent received therapeutic phlebotomy services in a hospital or physician's office and 30 percent in a blood center. Polycythemia vera: Diagnosis and treatment 2002. The authors stated that phlebotomy appeared to enhance the efficacy of non-pegylated IFN monotherapy for CHC, but more research was required to confirm this. Pflieger K.Pulmonary hypertension, Eisenmenger syndrome. A time for consensus? Adult congenital heart disease. Medicare Advantage (Part C) plans may cover more tests, depending on the plan. Read more about how MDsave works. Ann Intern Med. top: 0px; Medicare covers medically necessary blood tests ordered by a physician based on Medicare guidelines. In a Cochrane review, Wang and Dwan (2013) evaluated risks and benefits of chronic blood transfusion regimens in people with sickle cell disease to prevent first stroke or recurrences. Quantitative phlebotomy was employed to remove iron in 12 hyperuricemic patients with GA and maintained their body iron at near-iron deficiency (NID) level (i.e., the lowest body iron store compatible with normal erythropoiesis and therefore absence of anemia). Van Buren NL, Hove AJ, French TA, Gorlin JB. Gilbert HS. list-style-type: upper-alpha; OL LI { Wheeler CJ, Kowdley KV. Available at: https://www.renalandurologynews.com/home/news/nephrology/hyperuricemia/gout-risk-possibly-linked-to-iron-intake/. Sfeir HE, Klachko DM. The 3 largest RCTs excluded patients with cirrhosis. You will need to stay seated for several minutes and then stand up slowly. Greenway A, Ware RE, Thornburg CD. There is no. Cook LS. Effective January 2023, all therapeutic phlebotomy physician's orders must be submitted electronically. The appropriate dose is 75 to 100 mg/day. The 2023 edition of ICD-10-CM E83.119 became effective on October 1, 2022. Gout risk possibly linked to iron intake. All RCTs on BL or related interventions will be included. Barbieri et al (2009) described the first 2 cases of porphyria cutanea tarda associated with beta-thalassemia major. Lottenberg R, Hassell KL. Patient 3 had no anemia, a normal HFE genotype, and no coding region mutations in HAMP, FPN1, HJV, or ALAS2; she was heterozygous for the TFR2 coding region mutation V583I (nt 1,747 G-->A, exon 15). Magnetic resonance imaging (MRI)-assessed liver iron concentration (LIC) decreased with deferasirox (mean 12.5 10.1 to 8.5 9.3 mg Fe/g dry weight [dw]; p = 0.0005 versus baseline) and phlebotomy (10.2 6.8 to 8.3 9.2 mg Fe/g dw; p = 0.05). 2011;86(4):357-361. Lancet. Furthermore, BLT could dramatically reduce CRP level (MD = -3.64, 95 % CI: -6.72 to -0.55, p = 0.02). The authors concluded that during a 28-month follow-up, maintenance of NID was found to be safe and beneficial in all patients, with effects ranging from a complete remission (CR) to a marked reduction of incidence and severity of gouty attacks. Hemochromatosis (including hereditary hemochromatosis); Individuals receiving testosterone therapy if hematocrit is greater than or equal to 54 % (or hemoglobin is greater than or equal to 180 g/L); Non-hereditary hemochromatosis iron overload with elevated hepatic iron concentration; Chronic hepatitis C (adjunctive therapy with interferon), Hyperferritinemia in alcohol liver disease, Myeloproliferative disorders without polycythemia vera, removal of 1 unit (450 to 500 ml) of blood weekly until the serum ferritin level is 10 to 20 ug/L, and. Therapeutic phlebotomy is the removal of red blood cells or serum iron from the blood. Scheduled phlebotomy goodies people who have too much iron in their bluts, such as from hemochromatosis, or anyone is creating too many red blood cells, such as with polycythemia.Removing blood regularly decreases iron plane included which body by reducing the number of iron-rich red blood cells. The authors stated that they have presented a protocol for a systematic review of BL for the common cold; they hoped that this study will form the basis to conduct additional research and provide evidence for the use of BL for the common cold. The meta-analysis revealed that BLT was highly effective in relieving pain (MD = -1.13, 95 % CI: -1.60 to -0.66, p < 0.00001), with marked alterations in the total effective (RR = 1.09, 95 % CI: 1.05 to 1.14, p < 0.0001) and curative rates (RR = 1.37, 95 % CI: 1.17 to 1.59, p < 0.0001). Indications for splenectomy include symptomatic portal hypertension, drug-refractory painful splenomegaly, and frequentred blood cellstransfusions. Basile J, Bloch MJ. 2001;38(1 Suppl 2):25-28. 2014;39(3):232-237. In 2 and 5 patients, deferasirox dose was increased to 15 and 20 mg/kg/day, respectively. Therapeutic Phlebotomy Therapeutic Phlebotomy Filter Sort By Product Name 1 Item Show 15 These products are for therapeutic purposes only for our patients. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; .arrowPurpleSmall, a:hover.arrowPurpleSmall { Advance Beneficiary Notice of Non coverage (ABN) - (must be completed for Medicare patients where the . #backTop { UnitedHealthcare developed the ICD-10 Online Resource Center to give care providers easy access to a variety of resources to ease their transition to the International Classification of Disease, 10th Revision (ICD-10) which took effect October 1, 2015. The mean follow-up was 566 days. Serum iron and ferritin concentrations are frequently elevated in patients with chronic viral hepatitis. Perloff JK, Marelli AJ, Miner PD. list-style-type: lower-alpha; Leukemia. Iron depletion was obtained within 28 weeks and was associated with endogenous production of EPO. The estimated rate of polycythemia at 6 months was 10.4 %, 12 months was 17.3 %, and 24 months was 30.2 %. If the hematocrit cannot be kept below the upper limit of normal, even when the serum testosterone concentration is at the low end of the normal range during testosterone treatment, the patient should be evaluated for hypoxia and sleep apnea. View Lab Locations Employment drug testing Moreover, these researchers stated that any patient who developed HCT of greater than 50 % was advised to obtain phlebotomy. Arthritis Res Ther. } The presently available treatment options in PV were discussed and recommendations for the clinical management were given. Blood-letting therapy for hypertension: A systematic review and meta-analysis of randomized controlled trials. All statistical analyses were carried out with Review Manager 5.3.
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