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Additional Information Regarding NCD110.21 – Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions

In response to inquiries CGS is receiving regarding Change Request (CR) 10318, Transmittal 2005 titled, "ICD-10 and Other Coding Revisions to National Coverage Determinations (NCDs)" that was released on January 18, 2018. CR 10318 contains the latest coding instructions to Centers for Medicare & Medicaid Services (CMS) NCDs. Business Requirement 10 specifically addresses coding changes for NCD 110.21, Erythropoiesis Stimulating Agents (ESAs) in Cancer.

CMS is in the process of re-reviewing the coding changes for NCD 110.21. Until this review is complete and CMS makes a final determination, the A/B Medicare Administrative Contractors (MACs) will not implement the edits contained in CR 10318. The A/B MACs will also reprocess any claims that were processed in error from January 1, 2018, that were processed with the additional codes included in CR 10318 as not payable with the –EC modifier.

I hope you find this responsive to your concerns regarding NCD 110.2l.


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