Required Modifiers for ESAs Administered to Non-ESRD

80.9 - Required Modifiers for ESAs Administered to Non-ESRD Patients (Rev. 3721, Issued: 02-24-17, Effective: 05-25-17, Implementation: 05-25-17) 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. The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario Two. Group Code: CO CARC: 4 RARC: N/A MSN: N/A 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. To return HCPCS J0881 or J0885 billed with more than one ESA modifier at the line item level, the contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario Two. Group Code: CO CARC: 16 RARC: N63 MSN: N/A