2025 HCPCS code CE
(Active) Effective Date: N/A Revision Date: N/A Modifiers for HCPCS codes - Modifiers Feed
Indicates an automated multi-channel laboratory (AMCC) test performed on an ESRD patient undergoing maintenance dialysis that is beyond the normal frequency limit covered by the composite reimbursement and is separately payable.
This modifier is used independently and does not typically have other modifiers applied to it.
Medical necessity for exceeding the usual frequency of AMCC testing must be clearly documented in the patient's record.It should be based on the individual patient's condition and clinical needs. The additional tests should be essential for appropriate diagnosis, treatment, or management of the patient's condition.
The ordering physician is responsible for ensuring the medical necessity of the additional AMCC tests.
In simple words: This code is used for billing certain blood tests for dialysis patients when the tests are done more often than usual.It tells the insurance company that this extra test is medically necessary and should be paid for separately.
This modifier is used when an ESRD facility or another facility performs an AMCC test on an ESRD patient undergoing maintenance dialysis. It signifies that the test, while reasonable and medically necessary, exceeds the frequency limits of the composite rate and is therefore separately reimbursable. It is appended to individual laboratory codes when they are separately billable due to exceeding frequency limits under the MCP.
Example 1: A patient receiving maintenance dialysis requires a calcium ionized test more frequently than covered by the composite rate due to unstable calcium levels., An ESRD patient experiences an acute complication requiring more frequent monitoring of specific blood parameters via AMCC testing., A patient undergoing maintenance dialysis at a facility experiences a change in treatment requiring additional AMCC tests beyond the usual frequency.
Documentation should support the medical necessity of exceeding the frequency limits for AMCC tests covered by the composite rate. The patient's medical record must clearly justify why the additional tests were required.
** Although reporting these modifiers (CD, CE, CF) is no longer required by ESRD facilities, other facilities performing AMCC tests on ESRD patients may still need to use them.Always check current payer-specific guidelines.
- Payment Status: Active
- Specialties:Nephrology
- Place of Service:"End-Stage Renal Disease Treatment Facility", "Independent Laboratory", "Office"