Bulletin: 05-209 - Healthcare Common Procedure Coding System (HCPCS) Updates to the Fiscal Intermediary Shared System (FISS) Edit for Epoetin Alfa and Darbepoetin Alfa

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Related Change Request (CR) #: 4206
Related CR Release Date: December 2, 2005
Related CR Transmittal #: 772
Effective Date: January 1, 2006
Implementation Date: April 3, 2006

Providers Type Affected:

Providers billing Medicare fiscal intermediaries (FIs) for services related to the administration of Epoetin Alfa and Darbepoetin Alfa to Medicare beneficiaries

Providers Action Needed:

STOP - Impact to You

This article is based on Change Request (CR) 4206, which terminates the Q codes for Epoetin Alfa and Darbepoetin Alfa and replaces them with J codes.

CAUTION - What You Need to Know

Effective January 1, 2006: Q0136 Epoetin Alfa for Non-ESRD use is replaced with J0885; Q0137 Darbepoetin Alfa for Non-ESRD use is replaced with J0881; Q4054 Darbepoetin Alfa for ESRD use is replaced with J0882; and Q4055 Epoetin Alfa for ESRD use is replaced with J0886.

GO - What You Need to Do

See the Background section of this article for further details regarding these changes.

Background:

The annual Healthcare Common Procedure Coding System (HCPCS) update effective January 1, 2006, changes the HCPCS for reporting and billing Epoetin Alfa and Darbepoetin Alfa. CR4206 terminates Q codes for Epoetin Alfa and Darbepoetin Alfa and replaces them with the J codes shown below, effective January 1, 2006:

J0881 (INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)) replaces Q0137 (Darbepoetin Alfa for Non-ESRD use);
J0882 (INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRD ON DIALYSIS)) replaces Q4054 (Darbepoetin Alfa for ESRD use);
J0885 (INJECTION, EPOETIN ALFA, 1000 UNITS (FOR NON-ESRD USE)) replaces Q0136 (Epoetin Alfa for Non-ESRD use);
J0886 (INJECTION, EPOETIN ALFA, 1000 UNITS (FOR ESRD ON DIALYSIS)) replaces Q4055 (Epoetin Alfa for ESRD use).

Note: CR4108 (Transmittal 737, dated October 31, 2005, http://www.cms.hhs.gov/transmittals/downloads/R737CP.pdf ) instructs providers to begin billing the new HCPCS effective January 1, 2006. The corresponding Medlearn Matters article (MM 4108) can be found at http://cms.hhs.gov/MLNMattersArticles/downloads/MM4108.pdf

All billing and payment instructions currently required for the Q codes in the Medicare Claims Processing Manual (Publication 100-4, Chapter 8, Section 60 (Separately Billable ESRD Items and Services), found at http://cms.hhs.gov/manuals/downloads/clm104c08.pdf on the CMS web site, will be applied to the new J codes upon implementation of this instruction.

According to CR4206, there are no other changes to the reporting and payment of Epoetin Alfa and Darbepoetin Alfa.

Implementation:

The implementation date for the instruction is April 3, 2006. Claims submitted on types of bills 12x, 13x, and 85x that contain J0882 and/or J0886 between the effective date and the April 3, 2006, implementation date will be paid on a reasonable cost basis.

However, the Medicare intermediaries will automatically adjust these claims after the implementation date and correct the payment and pay affected claims based on the appropriate fee.

Additional Information:

For complete details, please see the official instruction issued to your intermediary regarding this change. That instruction may be viewed at http://www.cms.hhs.gov/transmittals/downloads/R772CP.pdf on the CMS web site.

Assistance:

If you have any questions regarding this bulletin, please contact the appropriate Customer Contact Center at:

Maryland Providers: 1-866-488-0545
Pennsylvania Providers: 1-800-560-6170

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