Hematocrit Value Required on Claims, Electronic Billing of EPO Claims for ESRD
Procedure codes Q4055 (Epotin alfa) and Q4054 (darbepoetin alfa) for End Stage Renal Disease (ESRD) patients on dialysis require a Hematocrit (Hct) value. For ANSI 837 transactions, the Hct value is reported in 2400 MEA03 with a qualifier of R2 in 2400 MEA02.
For CMS form 1500 paper claims, the Hematocrit value should be reported in item 19. A missing Hct value will result in a denial due to lack of documentation. Please note this and submit claims accordingly.
For more information on this requirement, please see One-Time Notification (OTN) 39, Change Request (CR) 2963 on the CMS Web site at:
http://www.cms.hhs.gov/transmittals/downloads/R39OTN.pdf (pdf - 9 pages; 191KB)
For information on Electronic Billing of EPO Claims for ESRD, click here. (pdf - 1 page; 9KB)
Page Last Updated: Tuesday, 04-Dec-2007 13:19:16 CST
