ESRD: Placement of a List of Diagnostic Tests that are Considered End Stage Renal Disease (ESRD) Related in Publication 100-04, Chapter 16

This article is informational in nature and conveys that the purpose of Change Request (CR) 6515 is to place a listing of diagnostic tests that are considered ESRD-related as Exhibit 1 (new) at the end of Chapter 16 of the Medicare Claims Processing Manual.

This listing was inadvertently omitted from the manual during the implementation of CR 2906. The purpose of CR 2906 was to address specific areas of concerns regarding Medicare system edits for Skilled Nursing Facilities (SNF) consolidated billing (CB) to permit payment for certain diagnostic services furnished to beneficiaries receiving treatment for ESRD at an Independent Provider-based dialysis facility. One of the areas of concern was that providers and suppliers needed a listing of diagnostic tests that are considered ESRD-Related that would require the “CB” modifier. Consequently, a list defining specific diagnostic tests as ESRD-Related was included in CR 2906. This list applies only to SNF CB. According to CR 2906, any diagnostic services related to the beneficiary’s ESRD treatment/care must be submitted using the “CB” modifier, however, if these services are not on the list labeled as Attachment 1 in CR 2906 or the list being added to the Medicare Claims Processing Manual by CR6515, your Medicare contractor may require supporting medical documentation.