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-AY modifier


Our facility has just found out there is a -AY modifier that is new. What do you do when lab tests requested have various dx as well chronic renal disease, do you add -AY modifier and to what?


The AY modifier was created as a way for non ESRD facilities to identify laboratory tests and a handful of drugs that are now fall under consolidated billing if these services are provided by a non ESRD facility and are not related to the treatment of ESRD.  An excerpt from MedLearn Matters 7064 published January 14th is provided below.

Consolidated Billing
CR 7064 provides an ESRD consolidated billing requirement for limited Part B services included in the ESRD facility bundled payment. Certain laboratory services and limited drugs and supplies will be subject to Part B consolidated billing and will no longer be separately payable when provided for ESRD beneficiaries by providers other than the renal dialysis facility. Should these lab services, and limited drugs be provided to a beneficiary, but are not related to the treatment for ESRD, the claim lines must be submitted by the laboratory supplier or other provider with the new AY modifier to allow for separate payment outside of ESRD PPS. ESRD facilities billing for any labs or drugs will be considered part of the bundled PPS payment unless billed with the modifier AY. In addition, as noted above, Medicare will, however, allow separate billing for ESRD supply HCPCS codes (as shown on attachment 4 of CR 7064) by DME suppliers when submitted for services not related to the beneficiary’s ESRD dialysis treatment and such services are billed with the AY modifier.

Disclaimer: All articles intended for general consumption only and not as a recommendation for a specific situation. Readers should consult an official source (AHA, AMA, etc.) or a qualified attorney for specific legal guidance.
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