September 4, 2008
Payment for non-ESRD ESA services billed under HCPCS codes J0881/J0885
First Coast Service Options Inc. (FCSO) recently identified an issue that occurred with the implementation of the April 2008 release. It was discovered that claims meeting the criteria below were denied with reason code 55503 or 56000 in error based on the local coverage determination (LCD) for erythropoiesis stimulating agents (ESAs) – LCD ID L895:
• Claims submitted on or after April 7, 2008
• Dates of service on or after April 7, 2008
• HCPCS codes J0881 or J0885
• Submitted with a payable dual diagnosis combination.
This problem was identified, and corrected, on July 25, 2008, and it does not impact claims submitted on or after July 25, 2008.
Action by providers is voluntary
Providers may submit adjustments on claims for non-end stage renal disease (ESRD) ESA services that denied in error with reason code 55503 or 56000 based on the above criteria. However, FCSO will adjust the impacted claims once the data becomes available.
Source: Change request 5818
