HCPCS Modifier EA
Erythropoetic stimulating agent (ESA) administered to treat anemia due to anti-cancer chemotherapy.
HCPCS Procedure Codes
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
- CMS transmittal 1413, Change Request 5818 (PDF)
- CMS National Coverage Determination 110.21 - for Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions.
- CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 17, Section 80.8-80.12 (PDF)
- CMS Medicare Benefit Policy Manual (Pub. 100-02), Chapter 15, Section 50 (PDF)