CMS Pub. 100-04, ch. 8, § 60.4.6.4

In the hospital inpatient setting, payment under Part A for Aranesp is included in the

DRG.

In the hospital inpatient setting, payment under Part B is made on bill type 12x when

billed with revenue code 0636. The total number of units as a multiple of 1mcg is placed

in the unit field. Reimbursement is based on the payment allowance limit for Medicare

Part B drugs as found in the ASP pricing file.

In a skilled nursing facility (SNF), payment for Aranesp covered under the Part B EPO

benefit is not included in the prospective payment rate for the resident’s Medicare-covered SNF stay.

In a hospice, payment is included in the hospice per diem rate when treatment is related

to the terminal illness.

For a service furnished by a physician or incident to a physician’s service, payment is

made to the physician by the A/B MAC (B) in accordance with the rules for ‘incident to”

services. When Aranesp is administered in the renal facility, the service is not an

“incident to” service and not under the “incident to” provision.

With the implementation of the ESRD PPS, ESRD-related Aranesp is included in the

ESRD PPS payment amount and is not separately payable on Part B claims with dates of

service on or after January 1, 2011 for other providers, with the exception of a hospital

billing for an emergency or unscheduled dialysis session.