Facial Wasting Fillers: CMS Considers Question Of Coverage Qualification
This article was originally published in The Gray Sheet
Executive Summary
CMS says it is deciding whether reconstructive treatments for facial lipodystrophy syndrome, associated with human immunodeficiency virus medicines, can qualify for Medicare coverage under a statute that excludes cosmetic surgery from the federal program
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Medicare In Brief
Facial-filler coverage proposal: CMS is taking comments through Jan. 22 on its proposal to cover dermal injections for facial lipodystrophy syndrome only in HIV patients who are depressed because of the physical signs of HIV treatment. Under the proposal, all other indications would be nationally non-covered, the agency said, because "we did not find evidence of improvement in any other health outcomes." The coverage analysis focuses on two synthetic injectable products for treating HIV facial lipoatrophy: poly-L-lactic acid (Sculptra from Sanofi Aventis) and calcium hydroxylapatite (Radiesse from BioForm Medical). Currently coverage decisions for the treatment, which helps fill areas of fat lost in a patient's cheeks due to some HIV drug therapies, are left to local contractors. The Medicare agency opened the coverage analysis last July (1"The Gray Sheet" July 20, 2009), following a benefits category analysis opened last January (2"The Gray Sheet" Jan. 26, 2009). CMS plans a final decision by March 23
Medicare In Brief
Facial-filler coverage proposal: CMS is taking comments through Jan. 22 on its proposal to cover dermal injections for facial lipodystrophy syndrome only in HIV patients who are depressed because of the physical signs of HIV treatment. Under the proposal, all other indications would be nationally non-covered, the agency said, because "we did not find evidence of improvement in any other health outcomes." The coverage analysis focuses on two synthetic injectable products for treating HIV facial lipoatrophy: poly-L-lactic acid (Sculptra from Sanofi Aventis) and calcium hydroxylapatite (Radiesse from BioForm Medical). Currently coverage decisions for the treatment, which helps fill areas of fat lost in a patient's cheeks due to some HIV drug therapies, are left to local contractors. The Medicare agency opened the coverage analysis last July (1"The Gray Sheet" July 20, 2009), following a benefits category analysis opened last January (2"The Gray Sheet" Jan. 26, 2009). CMS plans a final decision by March 23
Clinicians, AIDS Activists Urge CMS Coverage Of Facial Wasting Treatments
Dermatologists, HIV clinicians and an AIDS activist group are urging CMS to cover reconstructive treatments for facial lipodystrophy syndrome, a disfiguring side effect of human immunodeficiency virus medications