This article serves as a reminder on the correct submission of hematocrit (HCT) and hemoglobin (HGB) levels on electronic claims, as many providers are having Erythropoiesis Stimulating Agent (ESA) claims returned as unprocessable.
As a result of the Tax Relief and Health Care Act of 2006 (TRHCA), effective for services on or after January 1, 2008, the most recent hemoglobin or hematocrit levels must be reported on any claim for a Medicare patient receiving one of the following:
- ESA administrations
- Part B anti-anemia drugs other than ESAs used in the treatment of cancer that are not self-administered
The hemoglobin and hematocrit test result number must be reported as a 4-byte value (three numbers with a decimal point between the second and third number). These numbers must follow the format of NN.N. If the test result is fewer than three numbers, enter zeroes to ensure the decimal is given in the correct position. For example:
- If a 3-digit number is being reported (such as 31.2), enter 31.2
- If a 2-digit number is being reported (such as 4.5), enter 04.5
- If a 2-digit whole number is being reported (such as 28), enter 28.0
- If a single decimal position needs to be reported (such as .9), enter 00.9
- If a 1-digit whole number is being reported (such as 7), enter 07.0
- If a test result is being reported as 2-digits and 2 decimal places (such as 26.25), enter 26.2
The instructions for reporting the test results on professional electronic claims (837P) state to report the hemoglobin or hematocrit readings in Loop 2400 MEA segment. The specifics are:
- MEA01=TR (for test results)
- MEA02=R1 (for hemoglobin) or R2 (for hematocrit)
- MEA03= (for the test results). For example: 2400/MEA/TR/R1/27.5.
Questions?
- Ohio and West Virginia providers: call the Provider Contact Center at (866) 332-7025 for questions regarding this article. For questions regarding how to report hemoglobin or hematocrit readings on electronic claims, contact EDI Technical Support at (866) 308-5438.
- South Carolina providers: call the Provider Contact Center at (888) 828-2092. For questions regarding how to report hemoglobin or hematocrit readings on electronic claims, contact EDI Technical Support at (866) 749-4301.