Question:

On which types of pharmacy claims must hematocrit or hemoglobin readings be reported?

Answer:

Effective January 1, 2008, the following claims must report the most recent hematocrit or hemoglobin reading for all claims billing for the administration of:

  • Erythropoiesis-stimulating agents (ESA) (J0881, J0882, J0885, J0886 and Q4081)
  • A Part B anti-anemia drug (other than ESAs) used in the treatment of cancer that are not self-administered.

For institutional claims the hemoglobin reading is reported with a value code 48 and a hematocrit reading is reported with the value code 49. Claims not reporting a value code 48 or 49 will be returned to the provider, according to section 80.8, chapter 17, Medicare Claims Processing Manual.

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