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US · guidance

CMS Pub. 100-02, ch. 11, App. A

Appendix A: Composite Rate Tests for Hemodialysis, IPD, CCPD, and Hemofiltration (Items in bold are non composite rate test)

activein force · 2026-08-25 – presentas-observed

Chemistry CPT

Code

Monthly Weekly 13 x

Quarter

Albumin 82040 X

Alkaline Phosphates 84075 X

ALT (SGPT) 84460

AST (SGOT) 84450 X

Bilirubin, total 82247

Bilirubin, direct 82248

Calcium 82310 X

Calcium ionized (billed with modifier

CD or CE) 82330 X

Calcium ionized (billed with modifier

CF) 82330 X

Chloride 82435 X

Cholesterol 82465

CK, CPK 82550

CO2 (bicarbonate) 82374 X

Creatinine 82565 X

GGT 82977

Glucose 82947

LDH 83615 X

Phosphorus 84100 X

Potassium 84132 X

Protein, total 84155 X

Sodium 84295

Triglycerides 84478

Urea nitrogen (BUN) 84520 X

Uric Acid 84550

History

(Rev. 171, Issued: 06-07-13, Effective: 01-01-11, Implementation: 09-09-13)

Provenance

Source
cms.gov
Retrieved
2026-08-25
Edition
iom-2026-08-25
Content hash
9ddb1b5229042ca2c8edce2b8384514a6e99e58065f9eb9e2282d56b8e70d497
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