Tuesday, September 20, 2011

Assistant surgeon and Erythropoietin claim submission tips

Assistant surgeons or surgical assistants claim submission requirements


The practice of directing or using non-participating providers significantly increases the costs of services for our members. As such, UnitedHealthcare requires our participating providers to use reasonable commercial efforts to utilize the services of in network providers, including in-network surgical assistants or assistant surgeons to render services to our members. Health care professionals acting as assistant surgeons must report their health care services under the primary surgeon’s TIN. Payment is subject to our payment policies (reimbursement policies).



Erythropoietin (For Commercial members)
For Erythropoietin (EPO) claims submitted via paper to UnitedHealthcare on a CMS-1500 Form, enter the Hematocrit  (Hct) level in the shaded area of line 24A in the same row as the J-code. Enter Hct and the lab value (Hctxx). For electronic claims, the Hct level is required in the (837P) Standard Professional Claim Transaction, Loop 2400 – Service Line, segment MEA, Data Element MEA03. The MEA segment should be reported as follows:

• MEA01 = qualifier “TR”, meaning test results
• MEA02 = qualifier “R2”, meaning hematocrit
• MEA03 = hematocrit test result
Example: MEA*TR*R2*33~
The following J codes require an Hct level on the claim:
• J0881 D arbepoetin alfa (non-ESRD use)
• J0882 D arbepoetin alfa (ESRD on dialysis)
• J0885 Epoetin alfa (non-ESRD use)
• J0886 Epoetin alfa, 1,000 units (for ESRD on Dialysis)
• Q4081 Epoetin alfa (ESRD on dialysis)
For EPO claims submitted on a UB04 claim form, an Hct level is not required.

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