In simple words: This code is used when a dialysis center orders a standard blood test for a dialysis patient, and the cost of the test is already included in the overall dialysis treatment payment. Therefore, it's not billed separately.

This modifier is used when an End-Stage Renal Disease (ESRD) facility or Monthly Capitation Payment (MCP) physician orders an Automated Multi-Channel Chemistry (AMCC) test for an ESRD patient undergoing maintenance dialysis and the test is included within the ESRD composite rate payment. Therefore, the test is not separately payable.

Example 1: A patient receiving maintenance dialysis at an ESRD facility has a complete metabolic panel (CMP) performed.Since the CMP is part of the bundled ESRD services, modifier CD is appended to the CPT codes for the individual tests included in the CMP to indicate they are not separately billable., An ESRD patient undergoing dialysis requires an AMCC test for monitoring electrolyte levels, which is part of the routine dialysis care. Modifier CD is used to denote that this test is within the composite rate., A patient with ESRD receiving maintenance dialysis needs a more frequent electrolyte monitoring than usually included in the composite rate due to fluctuating levels. Additional AMCC tests ordered for this patient would require modifier CE, not CD.

Documentation should support the medical necessity of the dialysis treatment and the inclusion of the AMCC tests within the composite rate.

** As of December 1st, 2024, the information provided is based on the available data and may be subject to change with updates to coding guidelines and regulations.