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

In relation to the ‘Part B Editing for NCD 110.21 - Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions’ notification published on December 4, 2024, Noridian will be conducting recoupments on inappropriately paid claims for a period of four years (January 1, 2021 - December 31, 2024) in accordance with Publication 100-04, Chapter 34, Section 10.11.

Per NCD 110.21, services shall deny when reported with a hemoglobin level of 10.0g/dL or greater or a hematocrit level of 30% or greater. Claims identified to have been reported with levels greater than the aforementioned will be recouped.

Please refer to the following resources for additional guidance:

Last Updated Jan 22 , 2025