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Apheresis

These services may or may not be covered by all CoOportunity Health plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan will be used to determine your coverage.

Administrative process

Prior authorization is not required for apheresis.

Coverage

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Apheresis is generally covered subject to the indications listed below, and per your plan documents.

Indications that are covered

  1. Apheresis is considered an appropriate and effective form of standard therapy for the following conditions:
    1. Hyperviscosity syndromes such as Waldenstrom's, macroglobunemia, cryoglobunemia, and multiple myeloma
    2. Myasthenia gravis
    3. Leukapheresis in the treatment of leukemia (debulking)
    4. Good pasture's syndrome
    5. Glomerulonephritis associated with antiglomerular basement membrane antibodies and advancing renal failure or pulmonary hemorrhages
    6. Guillain-Barre syndrome
    7. Amanitam (wild mushroom) poisoning
    8. Sodium chlorate poisoning
    9. Familial hypercholesteremia (see lipid apheresis criteria for further indications)
  2. Apheresis is appropriate for the following conditions when conventional therapy has failed:
    1. Progressive systemic sclerosis/scleroderma
    2. Systemic lupus erythematosus (SLE)
    3. Thrombocytopenic purpura (TTP)
    4. Rheumatoid vasculitis
    5. Chronic relapsing polyneuropathy
    6. Multiple Sclerosis

Indications that are not covered

  1. Apheresis has not been proven to be an efficacious clinical treatment and would not be covered for the following conditions:
    1. Raynaud's disease
    2. Psoriatic arthritis
    3. Acquired immune deficiency syndrome (AIDS)
    4. Amyotrophic lateral sclerosis (ALS)

Definitions

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Apheresis is a procedure in which blood is withdrawn from a donor and separated into its components. A portion of the blood (plasma, leukocytes, platelets, lipid, etc.) is retained, and the remainder is returned to the donor body by transfusion. Examples (list is not all inclusive) are plasmapheresis, leukapheresis, thrombocytapheresis and platelet pheresis. Apheresis is also called pheresis.

Codes

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If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

36511 - Therapeutic apheresis; for white blood cells
36512 - Therapeutic apheresis; for red blood cells
36513 - Therapeutic apheresis; for platelets
36514 - Therapeutic apheresis; for plasma pheresis
36515 - Therapeutic apheresis; with extracorporeal immunoadsorption and plasma reinfusion
36516 - Therapeutic apheresis; with extracorporeal selective adsorption or selective filtration and
plasma reinfusion

Bibliography

Schwartz, J., Winters, J. L., Padmanabhan, A., Balogun, R. A., Delaney, M., Linenberger, M. L., Szczepiorkowski, Z. M., Williams, M. E., Wu, Y. and Shaz, B. H. (2013), Guidelines on the Use of Therapeutic Apheresis in Clinical Practice—Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Sixth Special Issue. J. Clin. Apheresis, 28: 145–284.

This information is for most, but not all, CoOportunity Health plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

CoOportunity Health has contracted with HealthPartners Administrators, Inc. to provide claims processing, medical management and certain other administrative services.