HCPCS Modifier CB

Description
Service ordered by a renal dialysis facility (RDF) physician as part of the ESRD beneficiary's dialysis benefit, is not part of the composite rate, and is separately reimbursable.

Guidelines/Instructions
For dates of service prior to July 1, 2019, submit this modifier only for residents of a skilled nursing facility (SNF) who are in a Part A covered stay when it has been determined that:
  • The patient is entitled to Medicare based on End Stage Renal Disease (ESRD)
  • The test is related to the dialysis treatment for ESRD
  • The test was ordered by a doctor providing care to patients in the dialysis facility
  • The test is not included in the dialysis facility's composite rate payment

For dates of service on and after July 1, 2019, do not submit this modifier.

  • The CB modifier, previously used by Independent Labs when billing for separate payment outside the SNF Consolidated Billing for ESRD dialysis-related lab services, is no longer applicable
  • Claim detail lines received with modifier CB will be rejected as unprocessable 
References
  • CMS Pub. 100-04, Chapter 16, Section 40.6.2.3 (PDF, 526 KB)
  • Items and Services Subject to ESRD PPS Consolidated Billing website
  • MLN Matters article MM11061 (PDF, 129 KB)

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

Palmetto GBA Home

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Jurisdiction J Part A MAC

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Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

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PDAC

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Anonymous

 


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