# Aranesp J0881



## JBJ (Oct 20, 2008)

My facility is having the worst time getting these injections paid by Medicare.  I have followed the LCD for WPS using J0881 with 585._ and 285.21 for the diagnoses.  I add EC modifier as instructed by WPS.  I have the HCT and weight charted.  What am I missing?


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## jsth10 (Oct 20, 2008)

JBJ said:


> My facility is having the worst time getting these injections paid by Medicare.  I have followed the LCD for WPS using J0881 with 585._ and 285.21 for the diagnoses.  I add EC modifier as instructed by WPS.  I have the HCT and weight charted.  What am I missing?




I worked in Hematology and Oncology so I know how hard it is to get that drug paid.  It is not your fault.  It's Medicare!  I had to do appeals on every patient who was getting it.  That could be 40 patients a month.  They did start to pay them but only after I did the appeal and it took them a month to come back and pay it. I don't know what to tell you to get it paid.  Let me know if you find out.


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## Diana Lerro (Oct 20, 2008)

Is your facility documenting a decrease in Aranesp dosage when the Hgb/Hct exceeds the levels specified in the local coverage determination? As the counts improve, the Medicare contractors want to see that the dosage is titrated downward.


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## JBJ (Oct 20, 2008)

Actually, the dosage has remained the same in most patients.


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## kbarron (Oct 21, 2008)

Is it a part D drug? If so, it is not covered by Medicare.


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