Does the New PO Modifier Apply to Outpatient Therapy Services?

February 1, 2016
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Rick Gawenda
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In the CY 2015 Outpatient Prospective Payment System Final Rule, the Centers for Medicare and Medicaid Services (CMS) created a HCPCS modifier for hospital claims that is to be reported with every code for outpatient hospital items and services furnished in an off-campus provider-based department (PBD) of a hospital. Reporting of this new modifier was voluntary for CY 2015, with reporting required beginning on January 1, 2016.

I am often asked must off-campus therapy locations that are hospital based departments (i.e. billing under the hospital NPI number) use the PO modifier on all CPT codes submitted on the UB-04 claim form for outpatient physical, occupational and speech therapy services? The answer to the question is

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