modifier? - injection my clearinghouse

[tonplair@gmail.com]

Can anyone help me with an injection my clearinghouse is stating that it need a modifier and I am not sure because this is the first time keying a charge in for this injection. The injection is Aranesp 200mcg hcpc code is J0881. Do anybody know the correct modifier for this injection?

 

[relong]

Is it for Medicare? Some carriers require modifiers depending on the circumstance in which you're giving the aranesp (i.e. EC for non-ESRD anemia non-chemo).

If this is the first time you're submitting charges for an ESA and its for medicare its best to read completely through your LCD. There's alot involved and you'll keep getting denials until you've met all the requirements.

Good luck!

 

[tonplair@gmail.com]

modifier

The insurance for this patient is Medicare and he is diagnose with MGUS-IGA(273.1) and MDS(238.75).

 

[relong]

http://www.cms.gov/medicare-coverag...C+(10202,+MAC+-+Part+B)&s=14&bc=BBAAAAEAAAAA&

Here is the ESA LCD website for CGBA. You'll need the appropriate anemia dx + the MDS dx. EA modifier if the pts not getting chemo and EC if they're on chemo.