Description
Erythropoetic stimulating agent (ESA) administered to treat anemia due to anti-cancer chemotherapy.

HCPCS Procedure Codes

  • J0881
  • J0885
  • Q5106

Guidelines/Instructions
This modifier is effective for dates of service on or after January 1, 2008.

  • Non-end-stage renal disease (non-ESRD) claims for the administration of Erythropoiesis Stimulating Agents (ESAs) must contain one of the following HCPCS modifiers: EA, EB or EC. Non-ESRD claims for ESAs submitted without one of these modifiers will be rejected and must be corrected and resubmitted.
  • Report only one ESA modifier with each appropriate procedure code. If the ESA is submitted with multiple ESA modifiers, it will be rejected. 
  • Hematocrit and/or hemoglobin levels are required for the administration of ESAs or will be rejected.
  • For electronic claims, report the most recent hematocrit or hemoglobin level in Loop 2400 MEA segment. Specifically: MEA01=TR (for test results), MEA02=R1 (for hemoglobin) or R2 (for hematocrit), and MEA03=the test results. Enter the test results as follows: TR=test results, R1=hemoglobin or R2=hematocrit (a two position alpha-numeric element), and the most recent numeric test result (a three position numeric element [xx.x]).
  • For paper claims, report the most recent hematocrit or hemoglobin level in Item 19 of the CMS-1500 claim form
References

Contact Palmetto GBA JJ Part B Medicare

Provider Contact Center: 877-567-7271

Email JJ Part B

Contact a specific JJ Part B department


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