Content Section
|
Medicare Information Resource
|
Note: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material which is copyrighted by the American Medical Association (AMA). You are forbidden to download the files unless you read, agree to and abide by the provisions of the copyright statement. Read the copyright statement now (you will be linked back to here).
|
MIR-2007 06AB, June 2007
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
|
Requirement for Providing Route of Administration Codes for Erythropoiesis Stimulating Agents (ESA) (CR# 5480)
Note: This article was revised on April 30, 2007, to replace one of the HCPCS codes in the second paragraph under Background, (Q4055) with J0886. All other information is the same.
Provider Types Affected
Physicians, providers, and suppliers who bill Medicare contractors (carriers, including durable medical equipment regional carriers (DMERC) and DME Medicare administrative contractors (DME MAC), fiscal intermediaries (FI), including regional home health intermediaries (RHHI), and Medicare administrative contractors (MAC)) for providing ESA administration services to Medicare end-stage renal disease (ESRD) beneficiaries
What You Need to Know
CR 5480, from which this article is taken, instructs all providers and suppliers on the voluntary reporting of route of administration modifiers on claims for Erythropoiesis Stimulating Agents (ESA) for ESRD beneficiaries. Route of administration modifiers were published and effective January 1, 2007, for reporting on Medicare claims submitted on or after February 1, 2007, for dates of service on or after January 1, 2007. Please see the background section for details.
Background
Current claims processing requirements do not allow you to report the method of administering Erythropoiesis Stimulating Agents (ESA) – such as epoetin alfa (EPO) and darbepoetin alfa (Aranesp) – to treat your end stage renal disease (ESRD) patients who are anemic. However, in order to study the efficacy of both intravenous administration and subcutaneous administration methods of ESA administration, the Centers for Medicare & Medicaid Services (CMS) will begin requesting you to voluntarily report modifiers, which will indicate the method of ESA administration.
Specifically, CR 5480, from which this article is taken, announces that, effective for claims submitted on or after February 1, 2007 (with dates of services on or after January 1, 2007), all providers and suppliers who bill for administering ESA to ESRD beneficiaries (Healthcare Common Procedure Coding System (HCPCS) codes Q4081, J0882, or J0886) are encouraged to include:
- Modifier JA on the claim to indicate an intravenous administration or
- Modifier JB to indicate a subcutaneous administration.
You should be aware that in the future, this reporting of the route of ESA administration will be a requirement, and additional instructions will be issued at that time. But until then, a claim for an ESA that does not report the route of administration will not be returned to the provider, and will be paid the same as a claim that does report the route of administration. Also, be aware that renal dialysis facilities whose claims include charges for ESA administration by both methods should report them in separate lines in order to identify the number of administrations provided by each method.
Additional Information
You can find more information about route of administration codes for Erythropoiesis Stimulating Agents (ESAs) by going to CR 5480, located at http://www.cms.hhs.gov/Transmittals/downloads/R1212CP.pdf  on the CMS Web site. As attachments to this CR, you will find updated Medicare Claims Processing Manual, Chapter 8 (Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims), Section 60.2.3.1 (Requirement for Providing Route of Administration Codes for Erythropoiesis Stimulating Agents (ESA)); and Chapter 17 (Drugs and Biologicals), Section 80.11(Requirements for Providing Route of Administration Codes for Erythropoiesis Stimulating Agents (ESAs)).
If you have any questions, please contact your Medicare contractor at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM5480
Pub. 100-4, Transmittal# R1212CP, CR# 5480
Related CR Release Date: March 30, 2007
Effective Date: January 1, 2007
Implementation Date: June 29, 2007
The Medicare Physician Fee Schedule Fact Sheet, which provides general information about the Medicare Physician Fee Schedule, is now available in print format. To place an order for the fact sheet, visit the Medicare Learning Network at http://www.cms.hhs.gov/mlngeninfo  on the Centers for Medicare & Medicaid Services Web site and select “MLN Product Ordering Page” under the “Related Links Inside CMS” Section.
| CPT five-digit codes, descriptions, and other data only are copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS clauses apply. |
|
