Medicare claim billing

Medicare Notification:

PHYSICIAN (CLINIC) BILLING OF HCT OR HGB VALUES ON ERYTHROPOIESIS STIMULATING AGENT (ESA) CLAIMS

The following information must be submitted with each claim:

HCT or Hgb values:
For professional paper claims, test results are reported in item 19 of the Form CMS-1500 claim form. For electronic claims (837P), providers report the hemoglobin or hematocrit readings in Loop 2400 MEA segment. The specifics are MEA01=TR (for test results), MEA02=R1 (for hemoglobin) or R2 (for hematocrit), and MEA03=the test results.

In other words, EMC claims should map the correct amounts to the correct field when billed as indicated in BR 5699.5: "Contractors shall require the most recent hematocrit or hemoglobin test results to be reported on claims submitted with HCPCS codes J0881, J0882, J0885, J0886, and Q4081. Hematocrit or hemoglobin test results are reported in the MEA03 segment Loop 2400 of the 837P or item 19 of the Form CMS-1500 claim form." (If the area above is blank, the claim will deny)

ICD-9 codes (For 4010A1 electronic format):
The ICD-9 code for the cause of the anemia must be placed in 2300 Loop, HI Segment for electronic claims (item 21, #1 for CMS 1500 forms) and a pointer of 1 in Loop 2400, SV1 segment for electronic claims (#1 in item 24E on the CMS 1500 form).

If you received an unprocessable denial, the claim can be resubmitted with the correct information.

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