CMS issues revised ESA reimbursement instructions

Executive Summary

CMS issues formal instructions to administrative contractors on how to reimburse erythropoiesis-stimulating agents based on the national coverage decision issued July 30, 2007, restricting coverage of ESAs in the non-renal setting (1"The Pink Sheet" Aug. 6, 2007, p. 21). The updated coverage instructions were effective the day the NCD was issued and carry an implementation date of April 7, 2008. The new instructions focus on when to deny claims for non-end stage renal disease ESA treatments under HCPCS codes J0881 or J0885 billed with modifier EC (ESA, anemia, non-chemo/radio) and with modifier EA (ESA, anemia, chemo-induced) on or after Jan. 1, 2008...