If the Date of Service is on or after 1/1/2007, Epogen must be billed as an Ordered Ambulatory (fee-for-service) claim using HCPCS procedure code J0886. This can be billed using either the 837 Professional or the 837 Institutional (without a Rate Code).

If the Date of Service is prior to 1/1/2007, Epogen must be billed as a Rate Based claim, and the Rate Code used depends on whether the client has Medicare coverage or not:

If the client has Medicare coverage, Epogen is billed with Rate Code 3107.

If the client does not have Medicare, Epogen is billed with Rate Code 1806.