Billing and Coding: Erythropoiesis Stimulating Agents (ESAs)

ESA therapy is covered for anemia caused by decreased erythropoietin production or resistance (for example chronic renal failure/ESRD), with goals generally to maintain HCT 30.0-36.0% (Hb 10.0-12.0 g/dL). ESAs are contraindicated in uncontrolled hypertension and must not replace urgent RBC transfusion; documentation must include recent Hb/HCT, blood pressure, weight, dose and route, and specific HCPCS codes and modifiers as required, with claims missing Hb/HCT returned.

"ESA therapy is indicated for anemia due to decreased erythropoietin production or relative erythropoietin resistance, e."

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