| Modifier | Description |
|---|---|
| EA | ESA administered to treat anemia due to anti-cancer chemotherapy |
| EB | ESA administered to treat anemia due to anti-cancer radiotherapy. |
| EC | ESA administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy |
| AX | Item furnished in conjunction with dialysis services |
| AY | Item or service furnished to an ESRD patient that is not for the treatment of ESRD |
| ED | Hematocrit greater than 39.0% or hemoglobin greater than 13.0g/dL for 3 or more consecutive billing cycles immediately prior to and including the current billing cycle |
| EE | Hematocrit greater than 39.0% or hemoglobin greater than 13.0g/dL for less than 3 consecutive billing cycles immediately prior to and including the current billing cycle |
| EJ | Subsequent claims for a defined course of therapy, e.g., EPO, Sodium Hyaluronate, Infliximab |
| EM | Emergency reserve supply for ESRD benefit only. In event that schedule was changed, provider should note changes in medical record and bill according to revised schedule. For patients beginning to self-administer an ESA at home receiving an extra month supply of drug, bill one-month reserve supply on one claim line and include this modifier. |
| G1 | Most recent urea reduction ratio (URR) reading of less than 60 |
| G2 | Most recent URR reading of 60 to 64.9 |
| G3 | Most recent URR reading of 65 to 69.9 |
| G4 | Most recent URR reading of 70 to 74.9 |
| G5 | Most recent URR reading of 75 or greater |
| G6 | ESRD patient for whom less than six dialysis sessions have been provided in a month |
| GS | Dosage of Epoetin Alfa (EPO) or Darbepoetin Alfa has been reduced and maintained in response to hematocrit or hemoglobin level. |
| JA | Administered intravenously |
| JB | Administered subcutaneously |
| JE | Administered via dialysate |
| V5 | Any vascular catheter (alone or with any other vascular access) - Part A only modifier |
| V6 | Arteriovenous graft (or other vascular access not including a vascular catheter) - Part A only modifier |
| V7 | Arteriovenous fistula (or other vascular access not including a vascular catheter) - Part A only modifier |
| V8 | Dialysis related infection present during the billing month - Part A only modifier |
| V9 | No dialysis related infection present during the billing month - Part A only modifier |