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Modifier EB | Description, Billing Guidelines & Reimbursement

The EB modifier is used for ESA’s to treat anemia due to anti-cancer radiotherapy. Below the description, billing guidelines and reimbursement for this modifier.

What Is Modifier EB?

The EB modifier is defined by the CPT manual as: “Erythropoetic stimulating agent (ESA) administered to treat anemia due to anti-cancer radiotherapy.”

CMS uses modifier EB 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 EB Modifier?

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 CMS EB (ESA, anemia, radio-induced) shall be denied.

Medicare and Modifier CMS EB: The CMS 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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