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CMS Answers Questions about Off-Campus PO Modifier

The Centers for Medicare & Medicaid (CMS) has released a frequently asked questions (FAQ) document that provides clarity for hospitals on when to include the Healthcare Common Procedure Coding System (HCPCS) PO modifier on hospital claims. Inclusion of the PO modifier became mandatory on Jan. 1.

The FAQ clarify that the recently passed Bipartisan Budget Act of 2015 will not affect the implementation of the PO modifier. Section 603 of this law requires Medicare to reimburse newly constructed, off-campus hospital outpatient departments at rates considerably lower than current rates, beginning Jan. 1, 2017.

Currently, provider-based, off-campus hospital outpatient departments are paid through the Outpatient Prospective Payment System (OPPS). CMS will set future rates for these departments through formal rulemaking in the OPPS proposed rule, expected to be released in late June or early July.

Contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.

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