HCPCS Modifier EB

Published 07/16/2020

Description
Erythropoetic stimulating agent (ESA) administered to treat anemia due to anti-cancer radiotherapy.

HCPCS Procedure Codes

  • J0881
  • J0885
  • Q5106

Guidelines/Instructions

  • Non-end-stage renal disease (non-ESRD) claims for the administration of erythropoiesis stimulating agents (ESAs) must contain one of the following HCPCS modifiers: EA, EB or EC. Non-ESRD claims for ESAs submitted without one of these modifiers will be rejected and must be corrected and resubmitted.
  • Report only one ESA modifier with each appropriate procedure code. If the ESA is submitted with multiple ESA modifiers, it will be rejected. 
  • Hematocrit and/or hemoglobin levels are required for the administration of ESAs or will be rejected.
  • For electronic claims, report the most recent hematocrit or hemoglobin level in Loop 2400 MEA segment. Specifically: MEA01=TR (for test results), MEA02=R1 (for hemoglobin) or R2 (for hematocrit), and MEA03=the test results. Enter the test results as follows: TR=test results, R1=hemoglobin or R2=hematocrit (a two position alpha-numeric element), and the most recent numeric test result (a three position numeric element [xx.x]).
  • For paper claims, report the most recent hematocrit or hemoglobin level in Item 19 of the CMS-1500 claim form

References

 


Was this article helpful?

Palmetto GBA Web Chat

Sounds: OnSave Transcript
Please answer the questions below. Additional fields may appear based on previous answers. Fields with a red asterisk (*) are required.
Your InformationClear
1()-x
Inquiry InformationClear
Select your stateClear
Select your stateClear
Provider InformationClear
Patient InformationClear
Patient Name must exactly match the information submitted on the claim, including suffix if applicable.
//
Appeal InformationClear
//
//
Claim InformationClear
//
//
Denial InformationClear
//
//
Rejection InformationClear
DDE InformationClear
Restore InformationClear
//
Prior Authorization InformationClear
//
//
Application InformationClear
Product InformationClear
OtherClear
Additional InformationClear

Are you sure you want to end your chat?

Keep ChattingClose ChatSave Transcript & Close

Webchat

Our dedicated webchat representatives are online to assist you with your general inquiries, provider enrollment, EDI, eServices and more in real-time.