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Usage of Modifiers EA, EB and EC


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 January 1, 2008, all non-ESRD claims billing HCPCS J0881 and J0885 must also begin reporting one of the following modifiers:

EA Erythropoetic stimulating agent (ESA) administered to treat anemia due to anticancer chemotherapy

EB Erythropoetic stimulating agent (ESA) administered to treat anemia due to anticancer radiotherapy

EC Erythropoetic stimulating agent (ESA) administered to treat anemia due to anticancer radiotherapy or anticancer chemotherapy.

Modifiers EA, EB and EC are valid only when submitted with the following HCPCS codes on non-ESRD claims for ESAs:

J0881 Injection, darbepoetin alfa, 1 mcg (non-ESRD use)

J0882 Injection, darbepoetin alfa, 1 mcg (for ESRD on dialysis)

J0885 Injection, epoetin alfa, (for non-ESRD use), 1000 units

J0886 Injection, epoetin alfa, 1000 units (for ESRD on dialysis)

Q4081 Injection, epoetin alfa, 100 units (for ESRD on dialysis)

Please note:

ESAs administered for more than one of the indicated therapies are to be 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. Claims that are billed without the required modifiers will be returned as unprocessable.

ESA treatment duration for each course of chemotherapy includes the 8 weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regime.

Providers should continue to utilize modifier EJ to report subsequent administrations of ESAs.

Know more about:

Modifier EA Usage and Reimbursement

Modifier EB Usage and Reimbursement


Modifier EC Usage and Reimbursement

Reference:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775132/

http://www.aetna.com/cpb/medical/data/100_199/0195.html

http://www.cgsmedicare.com/jc/pubs/insider/2008_insider_summer.pdf

http://www.bcbsal.org/providers/newPaymentMethodology/modifiers.pdf

http://apps.humana.com/tad/tad_new/Search.aspx?searchtype=beginswith&docbegin=E

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Drug%20Policies/Anemia_Drugs_darbepoetin_alfa_and_epoetin_alfa.pdf

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/UnitedHealthcare%20Medicare%20Coverage/Medications_SH_Ovations.pdf

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Clinician%20Resources/Erythropoietin%20(EPO)%20Drug%20Policy/FDA%20Alert%20on%20EPO%203-9-07.pdf

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