Implementation of Changes in End Stage Renal Disease (ESRD) Payment for Calendar Year (CY) 2012

In the CY 2011 ESRD PPS final rule, CMS finalized a specific list of routine ESRD-related laboratory tests included as part of consolidated billing. CR 7497, entitled, “Independent Laboratory Billing of Automated Multi-Channel Chemistry (AMCC) Organ Disease Panel Laboratory Tests for Beneficiaries who are not Receiving Dialysis for Treatment of End Stage Renal Disease (ESRD),” sunset the requirement for independent laboratories to bill separately for each individual AMCC laboratory test included in organ disease panel codes for ESRD eligible beneficiaries. Because organ disease panels consist of AMCC laboratory tests that are ESRD-related laboratory services, it is important for CMS to ensure that these laboratory tests remain in the ESRD PPS bundle. CMS is adding the following organ disease panels (identified by HCPCS) to the list of laboratory items and services subject to consolidated billing for the ESRD PPS for dates of service on or after January 1, 2012: • 80047 – Basic metabolic panel (Calcium, ionized), • 80048 – Basic metabolic panel (Calcium, total), • 80051 – Electrolyte panel, • 80053 – Comprehensive metabolic panel, • 80061 – Lipid panel, • 80069 – Renal function panel, and • 80076 – Hepatic function panel. CMS is also adding the “Assay of protein by other source,” which is identified by the CPT code 84157 to the list of items and services subject to consolidated billing for the ESRD PPS effective for dates of service on or after January 1, 2012.