HCPCS Modifier CB

Published 07/16/2020

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 and 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Labs when billing for separate payment outside the SNF Consolidated Billing for ESRD dialysis-related lab services, is no longer applicable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, 569 KB)
  • Items and Services Subject to ESRD PPS Consolidated Billing website
  • MLN Matters article MM11061 (PDF, 195 KB)

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