HCPCS Modifier AY
Published 07/16/2020
Description
Item or service furnished to a patient that is not for the treatment of ESRD.
Guidelines
- Submit this modifier on Part B claims for end-stage renal disease (ESRD) patients for specific lab services and drugs/biologicals that are not related to the treatment for ESRD. This modifier will allow payment for these non-ESRD services outside of the ESRD Prospective Payment System (PPS) if all other coding and coverage requirements are met (excluding services/drugs that CMS has determined to always be included in the PPS).
References
- CMS IOM 100-04, Chapter 8, Sections 50-60 (PDF, 663 KB)
- CMS IOM 100-02, Chapter 11, Section 20.2 and 20.3-20.4 (PDF, 468 KB)
- More information on ESRD PPS and services is included in ESRD Consolidated Billing