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30.2.24.6 Erythropoietin Alfa (EPO) and Darbepoetin
EPO and darbepoietin (procedure codes J0881 and J0885) are benefits of the CSHCN Services Program for the following diagnosis codes:
|
Diagnosis Code
|
Description
|
|
042
|
Human immunodeficiency virus (HIV)
|
|
20300
|
Multiple myeloma without mention of remission
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|
20301
|
Multiple myeloma in remission
|
|
2733
|
Macroglobulinemia
|
|
2800
|
Iron deficiency anemia secondary to blood loss (chronic)
|
|
2801
|
Iron deficiency anemia secondary to inadequate dietary iron intake
|
|
2808
|
Other specified iron deficiency anemias
|
|
2809
|
Unspecified iron deficiency anemia
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|
2810
|
Pernicious anemia
|
|
2811
|
Other vitamin B12 deficiency anemia
|
|
2812
|
Folate-deficiency anemia
|
|
2813
|
Other specified megaloblastic anemias not elsewhere classified
|
|
2814
|
Protein-deficiency anemia
|
|
2818
|
Anemia associated with other specified nutritional deficiency
|
|
2819
|
Unspecified deficiency anemia
|
|
2820
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Hereditary spherocytosis
|
|
2821
|
Hereditary elliptocytosis
|
|
2822
|
Anemias due to disorders of glutathione metabolism
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|
2823
|
Other hemolytic anemias due to enzyme deficiency
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|
28241
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Sickle-cell thalassemia without crisis
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|
28242
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Sickle-cell thalassemia with crisis
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|
28249
|
Other thalassemia
|
|
2825
|
Sickle-cell trait
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|
28260
|
Sickle-cell disease, unspecified
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|
28261
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Hb-SS disease without crisis
|
|
28262
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Hb-SS disease with crisis
|
|
28263
|
Sickle-cell/Hb-C disease without crisis
|
|
28264
|
Sickle-cell/Hb-C disease with crisis
|
|
28268
|
Other sickle-cell disease without crisis
|
|
28269
|
Other sickle-cell disease with crisis
|
|
2827
|
Other hemoglobinopathies
|
|
2828
|
Other specified hereditary hemolytic anemias
|
|
2829
|
Unspecified hereditary hemolytic anemia
|
|
2830
|
Autoimmune hemolytic anemias
|
|
28310
|
Unspecified nonautoimmune hemolytic amenia
|
|
28311
|
Hemolytic-uremic syndrome
|
|
28319
|
Other nonautoimmune hemolytic anemias
|
|
2832
|
Hemoglobinuria due to hemolysis from external causes
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|
2839
|
Acquired hemolytic anemia, unspecified
|
|
28401
|
Constitutional red blood cell aplasiac
|
|
28409
|
Other constitutional aplastic anemia
|
|
2841
|
Pancytopenia
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|
2842
|
Myelophthisis
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|
28481
|
Red cell aplasia (acquired) (adult) (with thymoma)
|
|
28489
|
Other specified aplastic anemias
|
|
2849
|
Unspecified aplastic anemia
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|
2850
|
Sideroblastic anemia
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|
2851
|
Acute posthemorrhagic anemia
|
|
28521
|
Anemia in chronic kidney disease
|
|
28522
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Anemia in neoplastic disease
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|
28529
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Anemia of other chronic illness
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|
2853
|
Antineoplastic chemotherapy induced anemia
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|
2858
|
Other specified anemias
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|
2859
|
Unspecified anemia
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|
40300
|
Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified
|
|
40301
|
Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end-stage renal disease
|
|
40310
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Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified
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|
40311
|
Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end-stage renal disease
|
|
40390
|
Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified
|
|
40391
|
Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end-stage renal disease
|
|
40402
|
Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage V or end-stage renal disease
|
|
40403
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Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end-stage renal disease
|
|
40412
|
Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage V or end-stage renal disease
|
|
40413
|
Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end-stage renal disease
|
|
40492
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Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage V or end-stage renal disease
|
|
40493
|
Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end-stage renal disease
|
|
586
|
Unspecified renal failure
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|
58889
|
Other specified disorders resulting from impaired renal function
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|
7140
|
Rheumatoid arthritis
|
|
99811
|
Hemorrhage complicating a procedure
|
|
V4983
|
Awaiting organ transplant status
|
|
V5811
|
Encounter for antineoplastic chemotherapy
|
|
V5812
|
Encounter for antineoplastic immunotherapy
|
|
V5844
|
Aftercare following organ transplant
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In addition to the diagnosis codes listed above, procedure code J0885 may also be considered for reimbursement with the following diagnosis codes:
Procedure codes J0882 and J0886 are benefits of the CSHCN Services Program for the following diagnosis codes:
|
Diagnosis Code
|
Description
|
|
042
|
Human immunodeficiency virus (HIV)
|
|
40300
|
Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified
|
|
40301
|
Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end-stage renal disease
|
|
40310
|
Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified
|
|
40311
|
Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end-stage renal disease
|
|
40390
|
Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified
|
|
40391
|
Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end-stage renal disease
|
|
40402
|
Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage V or end-stage renal disease
|
|
40403
|
Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end-stage renal disease
|
|
40412
|
Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage V or end-stage renal disease
|
|
40413
|
Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end-stage renal disease
|
|
40492
|
Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage V or end-stage renal disease
|
|
40493
|
Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end-stage renal disease
|
|
5851
|
Chronic kidney disease, Stage I
|
|
5852
|
Chronic kidney disease, Stage II (mild)
|
|
5853
|
Chronic kidney disease, Stage III (moderate)
|
|
5854
|
Chronic kidney disease, Stage IV (severe)
|
|
5855
|
Chronic kidney disease, Stage V
|
|
5856
|
End-stage renal disease
|
|
5859
|
Chronic kidney disease, unspecified
|
|
586
|
Unspecified renal failure
|
|
V420
|
Kidney replaced by transplant
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|
V560
|
Aftercare involving extracorporeal dialysis
|
|
V5631
|
Encounter for adequacy testing for hemodialysis
|
|
V5632
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Encounter for adequacy testing for peritoneal dialysis
|
|
V568
|
Encounter other dialysis
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EPO is limited to three injections per calendar week (Sunday through Saturday).
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