Wiki Multiple Modifiers for ESA Drugs

[kmiller070813]

I work for a health system and have a question on facility billing for multiple modifiers for ESA (epoetin, darbepoetin, etc.) drugs. HCPC codes are J0881 and J0882. We are required to bill the following modifiers on Medicare claims for these drugs:
JA/JB/JE - route of administration
JW/JZ - waste reporting
EA/EB/EC - anemia indication
JG - 340b drug
PO - provider based location
The electronic claim only allows up to 4 modifiers per the ANSI standard. We could potentially have up to 5 modifiers for these drugs on the claim. They are all informational modifiers that don't affect payment, so I was wondering how other facilities were handling this. I appreciate your feedback. Thanks.

 

[thomas7331]

When more modifiers are required than can be transmitted on a claim, you would use modifier 99 only and list all of the modifiers in the comments field or in any supporting documentation that you are submitting.

 

[kmiller070813]

Thank you Thomas. So on a UB, the modifiers would be listed in the Remarks (block 80). I appreciate your help.

 

[rachaelwilleford]

When more modifiers are required than can be transmitted on a claim, you would use modifier 99 only and list all of the modifiers in the comments field or in any supporting documentation that you are submitting.

Do you have a source for this that I can refer to?

 

[thomas7331]

Do you have a source for this that I can refer to?

Here's one from the Noridian DME MAC - I'd recommend looking for this in the policies of the payers specific to your practice: https://med.noridianmedicare.com/web/jddme/topics/modifiers/99#:~:text=Correct Use 1 Replace fourth modifier with modifier,pricing modifiers 5 Certain modifiers may affect payment