Question:
If lab services not related to ESRD are provided to patients in an ESRD facility, can the lab bill separately for them?
Answer:
Laboratory services that are not related to the treatment of end-stage renal disease (ESRD) are separately billable under the ESRD PPS and may be billed by either the ESRD facility or the independent laboratory. The bill must include the modifier AY, which serves as an attestation that the item or service is medically necessary for the dialysis patient but is not being used for the treatment of ESRD. For this information, see section 40.6 at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c16.pdf.
CPT® copyright 2024 American Medical Association (AMA). All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association.
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