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CMS Manual System Department of Health & Human Services (DHHS) Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 1412 Date: JANUARY 11, 2008 Change Request 5699 Subject: Reporting of Hematocrit or Hemoglobin Levels on All Claims for the Administration of Erythropoiesis stimulating Agents (ESAs), Implementation of New Modifiers for Non-ESRD Indications, and Reporting of Hematocrit/Hemoglobin Levels on all Non-ESRD, Non-ESA Claims Requesting Payment for Anti-Anemia Drugs I. SUMMARY OF CHANGES: Effective for all claims requesting payment for the administration of ESAs with dates of service on and after January 1, 2008, CMS, in conjunction with section 110 of Division B of the Tax Relief and Health Care Act legislation of 2006, will require that the most recent hematocrit and/or hemoglobin levels be reported, along with one of three designated modifiers.

Attachment - Business Requirements Pub. 100-04 Transmittal: 1412 Date: January 11, 2008 Change Request: 5699 SUBJECT: Reporting of Hematocrit or Hemoglobin Levels on All Claims for the Administration of Erythropoiesis Stimulating Agents (ESAs), Implementation of New Modifiers for Non-ESRD Indications,

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