BILLING NEWS

Repeat Tests for Automated Multi-Channel Chemistries for End Stage Renal Disease Beneficiaries

Clinical diagnostic laboratory tests ordered by an ESRD facility must follow CPT guidelines. Specifically, Modifier 91 must be used on any subsequent service being billed if 1) any single service (same CPT code) is ordered (for the same beneficiary), and 2) the specimen is collected more than once in a single day, and the service is medically necessary. Also, any line item on a claim with a modifier 91 will be included into the calculation of the 50/50 rule, and after the calculation of the 50/50 rule, services used to determine the payment amount may never exceed 22.


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INDUSTRY NEWS TAGS: CMS


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