US · guidance

CMS Pub. 100-04, ch. 8, § 60.4

Erythropoietin Stimulating Agents (ESAs)

activein force · 2026-08-25 – presentas-observed

Coverage rules for ESAs are explained in the Medicare Benefit Policy Manual,

Publication 100-02, Chapter 11.

ESAs and their administration supplies and staff are included in the payment for the

ESRD PPS effective January 1, 2011. Providers must continue to report ESAs on the

claim. ESAs are eligible for outlier payment consideration. The Medicare allowed

payment (MAP) amounts for the outlier policy include the ESA rate provided on the

Average Sale Price (ASP) list.

History

(Rev. 10640, Issued:08-06-21, Effective:09-07-21, Implementation:09-07-21)

Provenance

Source: cms.gov
Retrieved: 2026-08-25
Edition: iom-2026-08-25
Content hash: 7eb3b83f3ae602d6fd6c2e4ef6e52ac21e155ef7bf1b1c03395edba59055ba8c

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