Poh-Fitzpatric M.Porphyria cutanea tarda. # color: white; 2006;81(10):760-767. Aetna considers therapeutic phlebotomy medically necessary for any of the following indications: Footnote1* Forpersons with hematocrit greater than 60 %. Diagnosis and management of hemochromatosis: 2011 practice guideline by the American Association for the Study of Liver Diseases. 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. UpToDate [online serial]. Risk of bias will be assessed using the Cochrane Risk of Bias Assessment Tool, while confidence in the accumulated evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. 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. A total of 11 clinical trial papers involving 826 cases of migraine were included in the present paper; 3 of them were high-quality researches, and the other 8 were low quality researches. padding-right: 18px; } is proven and medically necessary for treating or managing the following conditions/diagnoses: Acute inflammatory demyelinating polyneuropathy (Guillain-Barr syndrome), primary treatment Acute liver failure [requiring High Volume Therapeutic Plasma Exchange (TPE-HV)] On the other hand, menstruating women are seldom afflicted by gout, because the monthly blood loss causes them to accumulate iron to a much lesser degree. The 10-year risk of leukemic/fibrotic transformation is less than 1 %/1 % in ET and less than 3 %/10 % in PV. 2003;73(2):121-125. The risk of allogeneic stem-cell transplantation-related complications is justified in transplantation-eligible patients whose median survival time is expected to be less than 5 years. 2000;7(3):249-255. Zhu Y, Yu H, Pan Y, et al. Interferon treatment regimes varied. Iron overload and prolonged ingestion of iron supplements: Clinical features and mutation analysis of hemochromatosis-associated genes in four cases. A JAK2 mutation is found in approximately 60 % of patients with ET. Kowdley KV, Brown KE, Ahn J, Sundaram V. ACG Clinical guideline: Hereditary hemochromatosis. Hepatocellular injury due to acute graft rejection might have contributed to elevated ferritin levels by causing release of stored iron from the hemosiderotic liver graft. Rochester, MN: Mayo Clinic; January 2000; Ch. Association of subcutaneous testosterone pellet therapy with developing secondary polycythemia. Thalassemia intermedia patients can be candidates of liver donors to decrease pre-transplant wait-list mortality. This observation promptedthese researchersto identify the potential utility of iron load reduction in the management of this disease. 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. Warnes CA. The changes induced by the treatment were assessed by clinical scores, biological tests, and neurophysiological study of cortical excitability using transcranial magnetic stimulation techniques. Phlebotomy & Blood Billing | Compliance Billing Specialist The authors concluded deferasirox treatment or phlebotomy reduced iron burden in pediatric patients with beta-thalassemia major post-HSCT, with a manageable safety profile. Therapeutic Phlebotomy Department 1021 112th Ave NE Bellevue, WA 98004 (800) 266-4033 or (425) 453-5098 Fax (425) 462-4316 . is therapeutic phlebotomy covered by insurance. } Abstract. } 2010;30(1):18-20. The mean follow-up was 566 days. Renal & Urology News, September 3, 2018. A total of 6prospective RCTs were identified: all used sustained viral response (SVR) as an endpoint. 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. Waltham, MA: UpToDate; reviewed May 2020. Waltham, MA: UpToDate; reviewed May 2015. 2019;25(2):139-146. Effective January 2023, all therapeutic phlebotomy physician's orders must be submitted electronically. Sustained viral response was attained in 50/182 (27 %) patients in the phlebotomy plus IFN group, compared to 22/185 (12 %) patients in the IFN group. You may need to wait in another room for a period of time. The mean Hb level at all clinic visits was 173 g/L (range of 134 to 205 g/L; n = 108); Hb concentrations of 180 g/L or more (calculated HCT of greater than or equal to 54%) were measured at 25 % of appointments. Does Insurance Cover Therapy? When, How to Check, and More Tips Blood Transfusion Service - Massachusetts General Hospital --> } The investigator cited a study (Facchini, 2003) showing that use of phlebotomy to maintain NID levels in patients with hyperuricemia was associated with a marked decrease in the incidence and severity of gouty attacks. The vast majority of Blue Cross Blue Shield insurance plans cover therapy. Furthermore, UpToDate reviews on Preventive treatment of migraine in adults (Bajwa and Smith, 2015) and Chronic migraine (Garza and Schwedt, 2015) do not mention phlebotomy as a therapeutic option. The moxibustion was adopted for 10 days. Haematologica. General Liability insurance cover medical expenses and attorney fees which result from bodily injuries and property damage that your company or organization could be. 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. Wang WC, Dwan K. Blood transfusion for preventing primary and secondary stroke in people with sickle cell disease. 2010;33(2):81-88. 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. Zhao Q-W, Liu J, Qu X-D, et al. Regulations regarding billing and coding have been added to the CMS National Coverage Policy section and removed from the Article Text. - (must be completed for Medicare patients where the reason for phlebotomy is not covered by insurance . Gumus, Abbasoglu O, Tanyel C, et al. 1999;4(105):208-214. The above policy is based on the following references: Last Review Treatment of hypertension in older adults, particularly isolated systolic hypertension. Almost all patients with PV harbor a JAK2 mutation. display: none; 2005:58-65. The relationship between ferritin and urate levels and risk of gout. Four classifications of blood disorders are discussed here for which symptoms and complications can be managed by the use of therapeutic phlebotomy. Zhongguo Zhen Jiu. /* aetna.com standards styles for templates */ Treatment with busulfan or interferon- is usually effective in hydroxyurea failures. During the trial, 11 children in the standard care group suffered a stroke compared to 1 in the transfusion group, odds ratio [OR] of 0.08 (95 % CI: 0.01 to 0.66). UpToDate [online serial]. This is the American ICD-10-CM version of E83.119 - other international versions of ICD-10 E83.119 may differ. The authors concluded that BLT was effective in alleviating pain and decreasing CRP level in AGA patients with a lower risk of evoking adverse reactions. } Disease activity control was evaluated as the primary outcome. Asian J Androl. Hepatology. UpToDate [online serial]. Where to go for Therapeutic Phlebotomy As a Polycythemia Vera patient, you can not give blood to the Red Cross. PDF CHAP11-CPTcodes90000-99999 Revision Date: 5/1/2022 CHAPTER XI - CMS After treatment, the UA, the ESR and the joint syndrome and symptom scores in the combination group decreased more apparently than those in the WM group (all p < 0.05). 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. Therapeutic phlebotomy is currently indicated for the treatment of hemochromatosis, polycythemia vera, porphyria cutanea tarda, sickle cell disease, and NAFLD with hyperferritinemia. Br J Dermatol. The trial closed early due to a significant difference in risk of stroke between participants who stopped transfusion and those who continued as measured by re-occurrence of abnormal velocities on Doppler examination or the occurrence of overt stroke in the group that stopped transfusion. OL LI { 2000;85(8):865-867. 2017;64(1):188-196. Lengfelder (2013) presented an overview on relevant topics of pathogenesis and diagnosis of PV. Second, UA over-production from ATP degradation. Li S-H, Hu W-S, Wu Q-F, Sun J-G. Therapeutic phlebotomy was performed every 41 weeks, and the initial procedure was performed at 5 mL/kg, although the subsequent phlebotomy volumes were increased to 10 mL/kg with a maximum of 500 mL in cases with Hb levels of 8 g/dL. Van Buren NL, Hove AJ, French TA, Gorlin JB. Links to various non-Aetna sites are provided for your convenience only. ol.numberedList LI { A total of 13sickle cell patients not ameliorated by conventional treatment entered a weekly venesection protocol (phlebotomy). Pflieger K.Pulmonary hypertension, Eisenmenger syndrome. #backTop { 04 . evoked migraine, pricking blood used as a complementary therapy, case report, specialists' experience summary, reviews, surveys, news articles, animal studies were excluded. Lengfelder E. Diagnosis and therapy of polycythemia vera in the era of JAK2. The most probable cause of hyper-ferritinemia was iron overload secondary to transplantation of a hemosiderotic liver. The authors concluded that the incidence of secondary polycythemia while on T pellet therapy may be higher than previously established. The follow-up trial (STOP 2) indicated that individuals may revert to former risk status if transfusion is discontinued. The iron deficiency induced by phlebotomies has no evident deleterious consequence either on height and weight in the children or on intellectual performance in any patients. 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. Under CPT/HCPCS Modifiers added modifier 59. Biomed Res Int. In 2 patients, direct sequencing was performed to detect coding region mutations of TFR2, HAMP, FPN1, HJV, and ALAS2. Besides, the Global Allergy and Asthma European Network (GA2LEN) recommended patient-reported outcomes (PROs) and health-related quality of life (HR-QOL) in patients with urticarial. Furthermore, BLT could dramatically reduce CRP level (MD = -3.64, 95 % CI: -6.72 to -0.55, p = 0.02). Haematologica. 2012;18(29):3782-3786. 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. Mean corpuscular volume, mean corpuscular Hb concentration and serum ferritin were also reduced. Instructions After Your Therapeutic Phlebotomy Procedure A time for consensus? The Cochrane Risk Assessment Tool was used to assess the methodological quality of trials. Lastly, these investigators demonstrated that BLT was safer than WM in treating AGA (RR = 0.36, 95 % CI: 0.13 to 0.97, p = 0.04). These findings suggested that individuals on TRT may be presenting to BCs as volunteer blood donors to avoid charges for TP. 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. Egan BM. Lancet. Am J Med. 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. The guideline developers recommend treatment by phlebotomy of patients with non-HFE iron overload who have an elevated hepatic iron concentration. Therapeutic phlebotomy may be indicated for hemochromatosis, polycythemia vera, porphyria cutanea tarda, and polycythemia secondary toarterio-venous fistulae, cyanotic congenital heart disease or cor pulmonale. Date of the latest search of the Group's Haemoglobinopathies Trials Register was January 28, 2013. There is no. #backTop:hover { Burden of Phlebotomy in Patients with Polycythemia Vera in the United Neurophysiol Clin. Du and colleagues (2014) evaluated the therapeutic effect of pricking blood therapy for migraine. In the WM group, 0.3 g ibuprofen was prescribed orally twice-daily for 10 days. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Early attempts to lower iron burden including chelation therapy and/or phlebotomy should be considered to avoid organ toxicity and transplant failure. 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. These researchers presented a pediatric case of a successful liver transplantation from a donor with beta-thalassemia intermedia. Fowler C. Hereditary hemochromatosis: Pathophysiology, diagnosis, and management. Therapeutic Phlebotomy - Medical Clinical Policy Bulletins | Aetna 1986;114(5):621-629. Valenti and colleagues (2012) stated that non-alcoholic fatty liver disease (NAFLD), defined by excessive liver fat deposition related to the metabolic syndrome, is a leading cause of progressive liver disease, for which accurate non-invasive staging systems and effective treatments are still lacking. Treatment of resistant hypertension. Some physicians may write a letter of medical necessity, which the patient can take to their insurance company to justify the procedure. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. You will need to stay seated for several minutes and then stand up slowly. 2019;114(8):1202-1218. A phlebotomy performed for therapeutic purposes is an eligible procedure and should be reported under code 99195 (phlebotomy, therapeutic). We will continue to require a therapeutic phlebotomy request form to be completed by your doctor and kept on file with Gulf Coast Regional Blood Center. Guidelines for the diagnosis, investigation and management of polycythaemia/erythrocytosis. Accessed July 23, 2022. You may have lightheadedness, dizziness, sweating, paleness, or fatigue after a phlebotomy. Phlebotomy has one course this removes family from the body. Omaha, NE: eMedicine.com; updated August 11, 2002. } Therefore, iron can increase the activity of xanthine oxidase, the sole enzymatic source of urate in human beings. This list only includes tests, items and services that are covered no matter where you live. You may have nausea or vomiting after this . } Exp Biol Med (Maywood). A patient, 6-year old girl, with a diagnosis of cryptogenic liver cirrhosis underwent deceased donor liver transplantation from a thalassemic donor. UpToDate [online serial]. The correlation between symptoms and hematocrit levels supports the importance of blood viscosity in contributing to this patient's symptoms. Rombos Y, Tzanetea R, Kalotychou V, et al. Procedure code 99195 may be reimbursed to physician assistant, advanced practice registered nurse (APRN), physician . } Hereditary hemochromatosis: A review of the genetics, mechanism, diagnosis, and treatment of iron overload. Typically, therapeutic phlebotomy consists of. Lottenberg R, Hassell KL. British Committee for Standards in Haematology. eMedicine Internal Medicine Topic 1864. Long-term results using hydroxyurea/phlebotomy for reducing secondary stroke risk in children with sickle cell anemia and iron overload. McLaren GD, Muir WA, Kellermeyer RW. Omaha, NE: eMedicine.com; updated December 18, 2001. Iron overload disorders: Natural history, pathogenesis, diagnosis, and therapy. During maintenance of NID for 28 months, gouty attacks markedly diminished in every patient, from a cumulative amount of 48 and 53 attacks per year before (year -2, -1), to 32, 11 and 7 during induction (year 0) and maintenance (year +1, +2) of NID, respectively. Dermatol Clin. An evidence-based approach to the treatment of adults with sickle cell disease. The treatment was well-tolerated except for muscle cramps and 1 popliteal vein thrombosis in a patient confined to chair. Tefferi A. Polycythemia vera and essential thrombocythemia: 2012 update on diagnosis, risk stratification, and management. Treatment of acute gouty arthritis by blood-letting cupping plus herbal medicine. OL OL LI { The authors concluded that the STOP trial demonstrated a significantly reduced risk of stroke in participants with abnormal transcranial Doppler ultrasonography velocities receiving regular blood transfusions. Seventy-six percent received therapeutic phlebotomy services in a hospital or physician's office and 30 percent in a blood center. Both authors independently assessed the risk of bias of the included trials and extracted data. Copyright Aetna Inc. All rights reserved. Dual therapy with hydroxyurea and phlebotomy may be an effective approach to patients with HbSC that do not experience improvement with hydroxyurea alone. High-risk patients with ET should be managed with cytoreduction, using hydroxyurea at any age. View Lab Locations Employment drug testing The changes of UA, high sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR) and the joint syndrome and symptom score before and after treatment were observed. PDF Therapeutic Phlebotomy Order Form - Erythrocytosis margin-bottom: 38px; Ann Intern Med. The authors stated that this study had several drawbacks. Dtsch Med Wochenschr. Third, the combination of different area selection and duration types of blood-letting therapy may have caused significant clinical heterogeneity. The following code (s) above E83.119 contain annotation back-references that may be applicable to E83.119 : E00-E89. Through the years phlebotomy has fallen out of favor for most medical conditions as it has been replaced with more focused treatments. Gilbert HS. right: 30px; Available at: http://www.emedicine.com/DERM/topic344.htm. Expert Rev Anticancer Ther. list-style-type: upper-alpha; Adverse effects with deferasirox were skin rash, gastro-intestinal (GI) upset, and increased liver function tests (all n = 1), while those for phlebotomy were difficulty with venous access (n = 4) and distress during procedure (n = 1). In a systematic review and meta-analysis of RCTs, these researchers examined the safety and effectiveness of blood-letting therapy for the treatment of chronic urticaria. 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. This can lead to fainting. Borgaonkar MR.Hemochromatosis. Hyperferritinemia and iron stores have been associated with the severity of liver damage in NAFLD, and iron depletion reduced insulin resistance and liver enzymes. The 2023 edition of ICD-10-CM E83.119 became effective on October 1, 2022. Moreover, the authors stated that confirmation of this will require RCT with detailed pre-treatment iron studies and appropriately powered to demonstrate a statistically significant benefit. World J Gastroenterol. Patients with hemochromatosis and iron overload should undergo therapeutic phlebotomy weekly (as tolerated). Then, a Meta-analysis was made by software Review Manager 5.1. For this reason, complementary and alternative medicine (CAM) therapies are used to improve the symptoms of the common cold. J Blood Med. 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. Available at: http://www.cachnet.org/learning_phlebotomy.html. This threshold has been interpreted by some physicians and patients to indicate the need for phlebotomy or blood donation while on TRT. Furthermore, an UpToDate review on Testosterone treatment of male hypogonadism (Snyder, 2021) states that The hematocrit should be measured after 3 to 6 months after initiating testosterone treatment and then yearly. 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. Blood-letting therapy for hypertension: A systematic review and meta-analysis of randomized controlled trials. Waltham, MA: UpToDate; reviewed May 2021. Chronic migraine. eMedicine Pediatrics Topic 2528. In the combination group, pricking blood was used at the most painful points of the red turgid and painful joint once every 3 days, a total 3 times; moxibustion was applied at the same joint for 15 to 20 mins, once-daily. padding: 15px; All About the Therapeutic Phlebotomy - Verywell Health Besa EC, Woermann U.Polycythemia vera. Bacon BR, Adams PC, Kowdley KV, et al, American Association for the Study of Liver Diseases. These are referred to as therapeutic phlebotomies. Get the phlebotomist professional liability insurance coverage through CM&F today! Preventive treatment of migraine in adults. Typically, therapeutic phlebotomy consists of removal of 1 unit (450 to 500 ml) of blood weekly until the serum ferritin level is 10 to 20 ug/L, and maintenance of the serum ferritin level at 50 ug/L or less thereafter by periodic removal of blood. ; Writing Committee of the General Haematology Task Force. 2016;241(7):737-744. A total of 144 hospitalization days were recorded in the7 patients in the year preceding the treatment. Estimated absorption of iron from supplements in patients 1 to 4 was 20.9 %, 1.9 %, 1.1 %, and 0.08 %. Pediatr Blood Cancer. The authorsinitiated a therapeutic phlebotomy program in order to lower the hematocrit to pre-splenectomy values, as well as to induce iron deficiency. Non-covered Services Certain services are never considered for payment by Medicare. At the end of the follow-up (up to 1 year), fatigue and walking capacities tended to improve in 2 patients. These include preventive examinations represented by CPT codes 99381-99397. Bloodletting therapy for patients with chronic urticaria: A systematic review and meta-analysis. The conditions/diagnoses under which a therapeutic phlebotomy can be paid are as follows: Polycythemia vera (238.4) Polycythemia secondary (289.0) to: Twenty percent of patients reported that phlebotomy procedures were moderately or extremely bothersome, inconvenient (18.3%), or painful or physically uncomfortable (16.3%). Presence of extreme thrombocytosis (platelet count greater than 1,000 10(9)/L) might be associated with acquired von Willebrand syndrome (AvWS) and, therefore, risk of bleeding. Basile J, Bloch MJ. hr.separator { covers blood you get as a hospital inpatient. A total of 40 patients with AGA were randomly divided into a pricking blood combined with moxibustion group (a combination group) and a WM group, 20 cases in each group. For example, iron, when added to media containing urate crystals, stimulated oxidative stress with subsequent complement and neutrophil activation. Monitoring response in PV and ET should use the ELN clinico-hematologic criteria. Peto odds ratio for SVR in phlebotomy plus IFN group was 2.7; 95 % CI: 1.6 to 4.5, p < 0.0001. Barton e al (2006) treated 4 white adults (1 man, 3 women) who had iron overload associated with daily ingestion of iron supplements for 7, 15, 35, and 61 years, respectively. Mean Hb concentration was 10.7 g/dL before phlebotomies and 8.8 to 9.2 g/dL during the4 years of treatment. Tefferi A. Prognosis and treatment of polycythemia vera. Accessed November 12, 2002. The doubtful applicability of this evidenceto pegylated IFN was also highlighted. Therapeutic phlebotomy is used to remove excess iron and maintain low normal body iron stores in patients with hemochromatosis. In: Mayo Clinic Cardiology Review Book. According to guidelines from the Hemochromatosis Management Working Group (Barton et al, 1998), therapeutic phlebotomy should be initiated in men with serum ferritin levels of 300 ug/L or more and in women with serum ferritin levels of 200 ug/L or more, regardless of the presence or absence of symptoms. Chin J Integr Med. Clinical observation of pricking blood combined with moxibustion for acute gouty arthritis. Noncovered Investigational Services ME | Tufts Health Plan If the phlebotomy was planned prior to the visit and nothing seperately identifiable was done you would eat the visit and only bill the phlebotomy. The authors concluded that the therapeutic effect of this therapy was satisfactory for AGA. These data also suggested that repeat blood donation was insufficient to maintain HCT of below 54 %. @media print { 2011;29(6):761-770. 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. Synder PJ. Hematology Am Soc Hematol Educ Program. 1983;19(3):205-266. Effective for dates of service on or after May 1, 2021, procedure code 99195 for therapeutic phlebotomy will become a benefit of the Children with Special Health Care Needs (CSHCN) Services Program. 1984;169(4):184-187. 63:1049-1066. Cook LS. .strikeThrough { The second trial (STOP II) investigated risk of stroke when transfusion was stopped after at least 30 months in this population. The mechanism of this effect is probably multi-factorial: The authorsobserved these two biological modifications intheir patients and suggested that they mediate the clinical effects. 2016;7:139-144. Results of meta-analysis indicated that the therapeutic effect of the pricking blood therapy was significantly superior to that of non-bleeding therapies in relieving migraine [OR = 6.23, 95 % CI: 4.03 to 9.63, Z = 8.24, p < 0.00 001]. 2009;55(2):36-39. Randomized and quasi-randomized controlled trials comparing blood transfusion as prophylaxis for stroke in people with sickle cell disease to alternative or no treatment were selected for analysis. The authors concluded that although some positive findings were identified, no definite conclusions regarding the safety and efficacy of BLT as complementary and alternative approach for the treatment of hypertension could be drew due to the generally poor methodological design, significant heterogeneity, and insufficient clinical data. De Gobbi et al (2000) noted that juvenile hemochromatosis is a rare genetic disorder that causes iron overload. 2018;20:179. Accessed November 12, 2002. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. (Accessed December 8, 2022) Home Blood Draws (Venipunctures) A total of 11 databases will be searched for studies conducted through June 2017.
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