Pharmacy Question for the Week of November 20, 2017

Pharmacy Compliance Question of the Week

Question:

What is the modifier to report with level II codes J0881 and J0885?

Answer:

Effective January 1, 2008, all non-end-stage renal disease (ESRD) claims containing J0881 and J0885 must report one of the following modifiers:

EA: ESA, anemia, chemo-induced

EB: ESA, anemia, radio-induced

EC: ESA, anemia, non-chemo/radio

Institutional claims that do not report one of the above modifiers will be returned to the provider.

Professional claims that are billed without the required modifiers will be returned as unprocessable.

For more on this, see the Medicare Claims Processing Manual, chapter 17, section 80.9 at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c17.pdf.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.