Pharmacy

Pharmacy Question for the Week of January 11, 2021

Pharmacy Compliance Question of the Week

Question:

Do erythropoiesis-stimulating agents (ESAs) qualify as highly complex drugs?

Answer:

It is generally accepted by all payers—Medicare as well as commercial insurers— that erythropoiesis-stimulating agents (ESAs) do not qualify as highly complex drugs, and therefore the IV push should be billed with 96374 (or 96375 if secondary) and not as a chemotherapy administration.


This question was answered in our Coding Essentials for Infusion & Injection Therapy Services. For more hot topics relating to infusion services, please visit our store or call us at 1.800.252.1578, ext. 2.

CPT© copyright 2020 American Medical Association (AMA). All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.