Pharmacy Question for the Week of January 11, 2021

Pharmacy Compliance Question of the Week


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


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.