Modifier AY

Item or service furnished to ESRD patient - not for ESRD treatment

Instructions

If an End Stage Renal Disease (ESRD) facility needs to report a lab service (not related to ESRD treatment), they must include modifier AY to indicate item/service was not for treatment of ESRD.

Correct Use

  • ESRD facilities reporting Daptomycin revision
    • Separate payment available for J0878 Injection (Daptomycin, 1 mg) when furnished to an ESRD patient (not for ESRD treatment)

Incorrect Use

  • Inappropriate to bill J0890 with modifier AY
    • Consolidated billing requirement - not overridden with AY modifier
  • Modifiers CD, CE and CF (also known as 50/50 rule modifiers) no longer valid for use on independent laboratory claims

Correct Claim Coding

Treatment CPT/Modifier
Assay of Creatinine 82565 AY

Resource

Last Updated May 12 , 2025