Part B Editing for NCD 110.21 - Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions

Effective January 1, 2025, system editing for Medicare Part B claims will reflect the NCD requirements in relation to the hematocrit and hemoglobin levels. The NCD states:

"shall deny non-ESRD ESA services for HCPCS J0881, J0885, Q5106 (7/1/18) billed with modifier -EA (ESA, anemia, chemo-induced) for anemia secondary to myelosuppressive anti-cancer 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."

Please refer to the following resources for any additional guidance:

Last Updated Dec 04 , 2024