tci Medicare Compliance & Reimbursement - 2007 Issue 31

MODIFIERS: Don't Forget The GS Modifier For High-Hemoglobin ESRD Patients

Check out these sticky new guidelines for ESAs.The Centers for Medicare & Medicaid Services (CMS) will crack down on coverage for erythropoiesis stimulating agents (ESAs) used to treat anemia in patients who receive dialysis for end-stage renal disease (ESRD). Since CMS last updated its coverage, the Food & Drug Administration issued a "black box" warning, saying that large doses of ESAs are risky for ESRD patients with hemoglobin levels above 12 g/dL.Effective next January, Medicare will continue to pay the same for ESAs for patients with hemoglobin of between 10 and 12 g/dL. But for patients whose...

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