Self Administered ESA Supply

60.4.5.1 - Self Administered ESA Supply (Rev. 10640, Issued:08-06-21, Effective:09-07-21, Implementation:09-07-21) Initially, facilities may bill for up to a 2-month supply of an ESA for home dialysis beneficiaries who meet the criteria for selection for self-administration. After the initial two months’ supply, the facility will bill for one month’s supply at a time. Condition code 70 is used to indicate payment requested for a supply of an ESA furnished a beneficiary. Usually, revenue code 0635 would apply to EPO since the supply would be over 10,000 units. Facilities leave FL 46, Units of Service, blank since they are not administering the drug. For claims with dates of service on or after January 1, 2008, supplies of an ESA for self- administration should be billed according to the pre-determined plan of care schedule provided to the beneficiary. Submit a separate line item for each date an administration is expected to be performed with the expected dosage. In the event that the schedule was changed, the provider should note the changes in the medical record and bill according to the revised schedule. For patients beginning to self-administer an ESA at home receiving an extra month supply of the drug, bill the one month reserve supply on one claim line and include modifier EM defined as “Emergency Reserve Supply (for ESRD benefit only)”. When billing for drug wastage in accordance with the policy in chapter 17 of this manual, section 40.1 the provider must show the wastage on a separate line item with the modifier JW. The line item date of service should be the date of the last covered administration according to the plan of care or if the patient dies use the date of death. Condition code 70 should be reported on claims billing for home dialysis patients who self-administer anemia management drugs including ESAs.