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ESRD Reimbursement for AutoChems

All chemistries ordered for ESRD patients must be billed individually with the following modifiers:

  • CD - AMCC test that has been ordered by an ESRD facility that is part of the composite rate
  • CE - AMCC test that has been ordered by an ESRD facility that is a composite rate test, but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity
  • CF - AMCC test that is not part of the composite rate and is a separately billable test that has been ordered by an ESRD facility

Medicare will calculate the number of AMCC services provided for any given date of service and divide the number of services with a CD modifier by the total number of services. If the calculation is 50% or greater, the carrier will not pay for the test. If the result is less than 50%, the carrier will pay for all the services.

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