US · guidance
CMS Pub. 100-04, ch. 8, § 60.4.4.2
Epoetin Alfa (EPO) Provided in the Hospital Outpatient
Departments
(Rev. 2582, Issued: 11-02-12, Effective: 04-01-13, Implementation: 04-01-13)
When ESRD patients come to the hospital for an unscheduled or emergency dialysis
treatment they may also require the administration of EPO. Effective January 1, 2005,
EPO will be paid based on the ASP Pricing File.
Hospitals use type of bill 13X (or 85X for Critical Access Hospitals) and report charges
under the respective revenue code 0634 for EPO less than 10,000 units and revenue code
0635 for EPO over 10,000 units. Hospitals report the drug units based on the units
defined in the HCPCS description. Hospitals do not report value code 68 for units of
EPO. Value code 49 must be reported with the hematocrit value for the hospital
outpatient visits prior to January 1, 2006, and for all claims with dates of service on or
after January 1, 2008.
History
(Rev. 2582, Issued: 11-02-12, Effective: 04-01-13, Implementation: 04-01-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
9483a6476611c74399b12c901bf6ac17d453acc00949b6ac120b46b0303da454
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