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Reporting HCT / HGB Levels for ESAs and Anti-Anemia Drugs Other Than ESAs
The intent of this article is to clarify how to submit hemoglobin and hematocrit test results when billing electronically. It is advised you share this information with your software vendor. The data entered and displayed on your data-entry screen may not be exactly what is being sent to Medicare in the ANSI raw data file.
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
Failure to report these test results will result in your claim being returned as unprocessed.
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:
- Hemoglobin or Hematocrit readings: Loop 2400 MEA01=TR (Test Results)
- Hemoglobin: MEA02=R1
- Hematocrit: MEA02=R2
- Test results: MEA03 (3 digit plus decimal point numeric test result) Example 2400/MEA/TR/R1/27.5
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 be follow the format of NN.N.
Important: If the test result is fewer than three numbers, do not enter zeros before the decimal. 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 4.5
- 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 .9
- If a 1-digit whole number is being reported (such as 7), enter 7.0
- If a test result is being reported as 2-digits and 2 decimal places (such as 26.25), enter 26.2
In summary, the hemoglobin and hematocrit test result number should always be a 4-byte value (three numbers with a decimal point between the second and third number). In other words, these numbers must follow the format of NN.N. If the test result is less than three numbers, then zeroes must be entered in order to ensure the decimal is given in the correct position as is demonstrated in some of the previous examples.