Erythropoietin Stimulating Agents (ESAs)

60.4 - Erythropoietin Stimulating Agents (ESAs) (Rev. 10640, Issued:08-06-21, Effective:09-07-21, Implementation:09-07-21) Coverage rules for ESAs are explained in the Medicare Benefit Policy Manual, Publication 100-02, Chapter 11. ESAs and their administration supplies and staff are included in the payment for the ESRD PPS effective January 1, 2011. Providers must continue to report ESAs on the claim. ESAs are eligible for outlier payment consideration. The Medicare allowed payment (MAP) amounts for the outlier policy include the ESA rate provided on the Average Sale Price (ASP) list.