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Modifier EB Usage and Reimbursement - Know when to use


CMS uses this modifier to gather information to determine the prevalence and severity of anemia associated with cancer therapy, the clinical and hematologic responses to the institution of antianemia therapy, and the outcomes associated with various doses of antianemia therapy.


Effective for claims with dates of service on and after January 1, 2008, non-ESRD ESA services for HCPCS J0881 or J0885 billed with modifier EB (ESA, anemia, radio-induced) shall be denied.

Medicare and Modifier EB: The EB modifier is non-covered. If billed with and ESA the claim will be denied.

Reimbursement

Payments for ESAs are based on reasonable and necessary determinations established by NCD. Provider may have the beneficiary sign an Advanced Beneficiary Notice, making the beneficiary liable for services not deemed reasonable and necessary and thus not covered by Medicare.

Know more about on the usage of modifiers EA & EC


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