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NCD 110.21 Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions Effective July 1, 2018, CMS added Q5106 Injection, epoetin alfa, biosimilar, (Retacrit) (for non-ESRD use), 1,000 units to the list of codes: Part A MACs and FISS shall deny Q5106 billed with modifier EC ESA, anemia, non-chemo/radio when any one of the specified noncovered diagnosis codes is present on the claim

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Anthem policy further deviates from administrative simplification, CPT standards and KMA policy: KMA endorses AMA-CPT as the standard accepted coding system in Kentucky and (notes that) proper use of CPT by insurance carriers requires adherence to all of its rules and guidelines. Examples of Proper Use of the 25 Modifier Example One A patient has a nosebleed

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