Changes to the ESRD PPS Consolidated Billing (CB) Requirements for Laboratory Services Furnished in a Hospital Emergency Room or Department

For Calendar Year (CY) 2012, CMS is making the following policy changes to the ESRD PPS outlier policy. CMS is eliminating, as of January 1, 2012, the requirement that hospitals append an AY modifier to laboratory tests that are billed as part of an emergency room or department visit. In an emergency room or emergency department, diagnostic laboratory testing is ordered according to the illness the patient is presenting, and it may not be feasible for the ordering physician to know at the time the laboratory test is being ordered if it is being ordered for reasons of treating the patient’s ESRD. Emergency rooms or emergency departments will not be required to append an AY modifier to these laboratory tests when submitting claims with dates of service on or after January 1, 2012.

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