Description
Erythropoetic stimulating agent (ESA) administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy.

HCPCS Procedure Codes

  • J0881
  • J0885
  • Q5106

Guidelines/Instructions

  • 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 with remark codes MA130 and CO-16 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 with remark codes MA130 and N63 and reason code CO-16. 
  • Hematocrit and/or hemoglobin levels are required for the administration of ESAs or will be rejected with remark codes MA130 and N764 and reason code CO-16
  • 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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