Description : Services Ordered by a Dialysis Facility Physician as Part of the ESRD Beneficiary’s
Dialysis Benefit, is not Part of the Composite Rate, and is Separately Reimbursable.
Required for Claims : End-Stage Renal Disease (ESRD) Facilities
Type of Bill: 72X
{NOTE: This modifier affects consolidated billing rules for skilled nursing facilities (inpatient)}
Coding Guidelines : The –CB modifier may only be applied for services related to the dialysis treatment and ordered by the dialysis facility physician.
General Guidelines :
The provider may use the modifier ONLY when it has determined that:
• a beneficiary has ESRD entitlement;
• the test is related to the dialysis treatment for ESRD;
• the test is ordered by a dialysis facility;
• the test is not included in the dialysis facility’s composite rate payment; AND
• the beneficiary is in a Medicare Part A stay (type of bill 21X or 22X)
ESRD related diagnostic tests refer to:
• the beneficiary must be an ESRD beneficiary;
• the test must have been ordered by an ESRD facility;
• the test must relate directly to the dialysis treatment of the beneficiary’s ESRD
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