ESRD Consolidated Billing

Section 1881(b)(14)(A)(i) of the Act requires the Secretary to implement a payment system under which a single payment is made for renal dialysis services and other items and services (for example, supplies and equipment used to administer dialysis, drugs, biologicals, laboratory tests, and support services) related to home dialysis. Consolidated billing requirements confer on the ESRD facility the payment responsibility for all of the renal dialysis services that their ESRD patients receive, including those services provided by other suppliers and providers.

The ESRD PPS includes consolidated billing 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 laboratory services, and limited drugs be provided to a beneficiary, but are not related to the treatment for ESRD, the claim lines must be submitted with the new AY modifier to allow for separate payment outside of ESRD prospective payment system.

ESRD facilities billing for ANY labs or drugs will be considered part of the bundled PPS payment unless billed with the modifier AY.