US · guidance
CMS Pub. 100-04, ch. 8, § 60.1
Lab Services
See the Medicare Benefit Policy Manual, Chapter 11, for a description of lab services
included in the PPS rate.
Renal dialysis facilities must bill all lab tests provided for the treatment of ESRD. This is
true whether the tests were provided directly or under arrangements with an independent
lab. When lab tests are billed by providers other than the ESRD facility and the lab test is
provided for the treatment of ESRD, the claim will be rejected or denied. In the event
that a lab test usually provided for the treatment of ESRD was furnished to an ESRD
beneficiary for reasons other than for the treatment of ESRD, the provider may submit a
claim for separate payment using modifier AY.
ESRD facilities should only bill for lab tests related to the treatment of ESRD or other lab
tests performed by the dialysis facility (i.e. CLIA waived lab tests). Lab tests that are not
for the treatment of ESRD and are not performed by the ESRD facility are not to be
reported on the ESRD facility claim.
History
(Rev. 10640, Issued:08-06-21, Effective:09-07-21, Implementation:09-07-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
dfeb432f35e875e817529c3f3e4c4e24d3c4a8bb87d2a2275e783ea1e97eb972
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