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Official Description

Amcc test has been ordered by an esrd facility or mcp physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity

Short Descr	Med neces amcc tst sep reimb
Medium Descr	Med neces amcc tst sep reimb
Coverage	Special coverage instructions apply
MCM	4270.2
Added Date	1/1/2004

Modifiers

CA-CT C Modifiers

CA Procedure payable inpatient

CB Esrd bene part a snf-sep pay

CC Procedure code change

CD Amcc test for esrd or mcp md

CE Med neces amcc tst sep reimb

CF Amcc tst not composite rate

CG Policy criteria applied

CH 0 percent impaired, ltd, res

CI 1 to <20 percent impaired

CJ 20 to <40 percent impaired

CK 40 to <60 percent impaired

CL 60 to <80 percent impaired

CM 80 to <100 percent impaired

CN 100 percent impaired, ltd

CO Outpatient ot service by ota

CQ Outpatient pt service by pta

CR Catastrophe/disaster related

CS Cost share waiver Covid-19

CT Ct does not meet nema standa

Date	Action	Notes
2004-01-01	Added	Code added 1/1/2004

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