What is modifier PO used for?

Effective January 1, 2015, the definition of modifier PO is “Services, procedures, and/or surgeries furnished at off-campus provider-based outpatient departments.” This modifier is to be reported with every HCPCS code for outpatient hospital services furnished in an off-campus provider-based department of a hospital.

What is modifier PN and PO?

The modifier -PO requirement has not been removed, but its definition was change to include only “excepted” department services. Modifier -PN is used for “nonexcepted” departments.

How does modifier PO affect reimbursement?

Moda Health Medicare Advantage follows CMS reporting requirements for modifier PO. G0463-PO will be reimbursed at an adjusted amount equal to the current CMS adjusted rate of payment, based upon date of service. 1. For 2019 dates of service, this is a 30% reduction to the OPPS fee schedule amount.

What is a non-excepted service?

This means “non-excepted” PBDs are those new off-campus PBDs that do not meet one of the above exceptions and that will no longer be paid under OPPS.

Does Medicare cover CPT code G0463?

Ordinarily, when a patient is seen at a HOPD clinic, the hospital bills Medicare for a clinic visit using HCPCS code G0463. This fee covers the hospital’s administrative expenses associated with the visit.

What is an ME modifier?

The modifiers ME, MF, and MG indicate to CMS that the order adhered, did not adhere, or was not applicable to the AUC respectively.

What is modifier 73 used for?

Modifier -73 is used by the facility to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated due to extenuating circumstances or to circumstances that threatened the well being of the patient after the patient had been prepared for the procedure (including procedural pre-medication when …

What is the difference between modifier 25 and 27?

We can use modifier 25 and 27 together, so do not get confuse with both these modifier. Both modifiers are defined separately and so use them correctly with E&M codes. Use modifier -27 for multiple outpatient hospital evaluation and management (E/M) encounters on the same date.