CR 11061 July 1, 2019, Sunset of CB Modifier

CR 11061 sunsets the requirement for independent laboratories to use the “CB” HCPCS modifier to bill separately for renal dialysis laboratory tests.

Effective January 1, 2011, independent laboratories are no longer allowed to report the CB modifier. All laboratory tests determined to be furnished for the treatment of ESRD are paid in the ESRD facility bundled payment and therefore, may only be reported by the ESRD facility.

Therefore, effective with dates of service on or after July 1, 2019, the CB modifier, which is a payment mechanism for independent laboratories to report when requesting separate payment outside the SNF CB for ESRD dialysis-related services, will not be available.

Effective with dates of service on or after July 1, 2019, claims with the CB modifier will be returned to the provider (RTP) with the following codes:

Reason code 31164 – Invalid line item modifier or line item date of service is not within or equal to modifier effective and termination date

CARC Code 182 – “Procedure modifier was invalid on the date of service.”

Group Code CO – Contractual Obligation.

Source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11061.pdf