CMS Pub. 100-04, ch. 17, § 80.9

Patients

(Rev. 3721, Issued: 02-24-17, Effective: 05-25-17, Implementation: 05-25-17)

Effective January 1, 2008, all non-ESRD claims billing HCPCS J0881 and J0885 must

begin reporting 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.

The contractor shall use the following remittance advice messages and associated codes

when rejecting/denying claims under this policy. This CARC/RARC combination is

compliant with CAQH CORE Business Scenario Two.

Group Code: CO

CARC: 4

RARC: N/A

MSN: N/A

ESAs administered for more than one of the indicated therapies are billed as separate line

items (i.e., ESAs for chemo-induced anemia (EA modifier) are reported as separate line

items (e.g., J0881EA); ESAs for radio-induced anemia (EB modifier) are reported as

separate line items (e.g., J0885EB); ESAs for non-chemo/radio induced anemia (EC

modifier) are reported as separate line items (e.g., J0881EC). Only one of the three ESA

modifiers may be reported at the line item level.

To return HCPCS J0881 or J0885 billed with more than one ESA modifier at the line

item level, the contractor shall use the following remittance advice messages and

associated codes when rejecting/denying claims under this policy. This CARC/RARC

combination is compliant with CAQH CORE Business Scenario Two.

Group Code: CO

CARC: 16

RARC: N63

MSN: N/A