Required Modifiers for ESAs Administered to Non-ESRD Patients (Rev. 1412, 04-07-08)

by  Jared Staheli
July 9th, 2015

Effective January 1, 2008, all non-ESRD claims billing HCPCS J0881 and J0885 must begin reporting one of the following modifiers:

EA: ESA, anemia, chemo-induced

EB: ESA, anemia, radio-induced

EC: ESA, anemia, non-chemo/radio

Institutional claims that do not report one of the above modifiers will be returned to the provider.

Professional claims that are billed without the required modifiers will be returned as unprocessable.

Use Reason code 4 and Remark code MA 130 to return ESA services billed without one of the required modifiers.

ESAs administered for more than one of the indicated therapies are billed as separate line items (i.e., ESAs for chemo-induced anemia (EA modifier) are reported as separate line items (e.g., J0881EA); ESAs for radio-induced anemia (EB modifier) are reported as separate line items (e.g., J0885EB); ESAs for non-chemo/radio induced anemia (EC modifier) are reported as separate line items (e.g., J0881EC). Only one of the three ESA modifiers may be reported at the line item level.

Use Reason code 125 and Remark code N63 to return HCPCS J0881 or J0885 billed with more than one ESA modifier at the line item level.

References:

• Pub 100-04 Medicare Claims Processing Manual - Chapter 17