FISS Narrative:
This edit identifies an outpatient 13x, 14x, or 85x type of bill (TOB) for laboratory services under ESRD Consolidated Billing (CB) contains dates of service overlapping a covered ESRD outpatient claim, TOB 72x.

Explanation and Suggestion:
Outpatient services subject to ESRD CB which are not related to a patient’s ESRD diagnosis can be reimbursed separately. Provider must add an 'AY' modifier to appropriate line items on outpatient claim and system will bypass ESRD CB edits. You may refer to the ESRD Consolidated Billing homepage for a list of ESRD CB services.

Contact Palmetto GBA JM Part A Medicare

Provider Contact Center: 855-696-0705

Email Part A

Contact a specific JM Part A department

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC


National Supplier Clearinghouse MAC


RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries



Click to Chat Now