Question:

Are EPO and Aranesp paid for under the OPPS? If so, how should they be billed?

Answer:

Chapter 17—Drugs and Biologicals, section 80.10 of the Medicare Claims Processing Manual gives the following information about hospitals billing for Epoetin Alfa (EPO) and Darbepoetin Alfa (Aranesp) for non-ESRD (end-stage renal disease) patients.

For patients with chronic renal failure who are not yet on a regular course of dialysis, EPO and Aranesp administered in a hospital and billed as an outpatient service on type of bill 13x or inpatient Part B bill type 12x are paid under the Outpatient Prospective Payment System (OPPS). Non-OPPS hospitals are paid on reasonable charges.

Hospitals report charges under revenue code 0636. For EPO, hospitals report charges under revenue code 0636 with HCPCS code J0885 effective January 1, 2006. Aranesp is reported with HCPCS code J0881 effective January 1, 2006.

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