by Jared Staheli
July 9th, 2015
Effective April 1, 2003, for DOS on or after April 1, 2001, CWF will not apply the SNF CB edits to line items that contain the CB modifier. A provider or supplier may use the “CB” modifier only when it has determined that: (a) the beneficiary has ESRD entitlement, (b) the test is related to the dialysis treatment for ESRD, (c) the test is ordered by a doctor providing care to patients in the dialysis facility, and (d) the test is not included in the dialysis facility’s composite rate payment.
Those diagnostic tests that are presumptively considered to be dialysis-related and, therefore, appropriate for submission with the “ CB” modifier are identified in Exhibit 1. This list was not designed as an all- inclusive list of Medicare covered diagnostic services. Additional diagnostic services related to the beneficiary’s ESRD treatment/care may be considered dialysis-related. However, if these services are not included in our listing, the contractor may require supporting medical documentation.
When a hospital laboratory is billing for laboratory services ordered by an ESRD facility and the patient (beneficiary) is a SNF resident under a Part A stay, the hospital laboratory must use the “CB” modifier for those services excluded from consolidated billing.
Beneficiaries in a SNF Part A stay are eligible for a broad range of diagnostic services as part of the SNF Part A benefit. Physicians ordering medically necessary diagnostic test that are not directly related to the beneficiary’s ESRD are subject to the SNF consolidated billing requirements. Physicians may bill the contractor for the professional component of these diagnostic tests. In most cases, however, the technical component of diagnostic tests is included in the SNF PPS rate and is not separately billable to the contractor. Physicians should coordinate with the SNF in ordering such tests since the SNF will be responsible for bearing the cost of the technical component.