EA modifier, modifier EA

Modifier EA | Description, Guidelines & Reimbursement

The EA modifier is used for anemia due to anti-cancer chemotherapy. Below you can find the description, billing guidelines and reimbursement for this modifier.

What Is Modifier EA?

Modifier EA is defined by the CPT manual as: “Erythropoetic stimulating agent (ESA) administered to treat anemia due to anti-cancer chemotherapy”.

CMS uses the EA 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.

When To Use An EA Modifier?

The EA modifier should only be reported when the ESA is being given for anemia resulting from myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma, and lymphocytic leukemia.

The corresponding anemia code must also be billed. Any other covered diagnosis code listed in the LCD for J0881 or J0885 will be denied if billed with the EA modifier.

Effective for Medicare claims with dates of service on and for non-ESRD ESA services for HCPCS J0881 or J0885 billed with modifier EA (ESA, anemia, chemo-induced) shall be denied for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma, and lymphocytic leukemia when a hemoglobin 10.0g/dL or greater or hematocrit 30.0% or greater is reported.

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 EB & EC

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