Aranesp J0881

JBJ

Contributor
Messages
15
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My facility is having the worst time getting these injections paid by Medicare. I have followed the LCD for WPS using J0881 with 585._ and 285.21 for the diagnoses. I add EC modifier as instructed by WPS. I have the HCT and weight charted. What am I missing?
 

jsth10

Networker
Messages
30
Location
Arlington, TX
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My facility is having the worst time getting these injections paid by Medicare. I have followed the LCD for WPS using J0881 with 585._ and 285.21 for the diagnoses. I add EC modifier as instructed by WPS. I have the HCT and weight charted. What am I missing?

I worked in Hematology and Oncology so I know how hard it is to get that drug paid. It is not your fault. It's Medicare! I had to do appeals on every patient who was getting it. That could be 40 patients a month. They did start to pay them but only after I did the appeal and it took them a month to come back and pay it. I don't know what to tell you to get it paid. Let me know if you find out.
 

Diana Lerro

Guest
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3
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Is your facility documenting a decrease in Aranesp dosage when the Hgb/Hct exceeds the levels specified in the local coverage determination? As the counts improve, the Medicare contractors want to see that the dosage is titrated downward.
 

JBJ

Contributor
Messages
15
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Actually, the dosage has remained the same in most patients.
 
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