Does the New PO Modifier Apply to Outpatient Therapy Services?

February 1, 2016
Rick Gawenda

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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