In November 2014, the Centers for Medicare and Medicaid Services (CMS) released the final rules for the outpatient prospective payment system (OPPS) and the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2015. In the OPPS final rule, CMS finalized they will begin to collect data on services furnished in off-campus provider-based departments in CY 2015. Hospitals will be required to report the HCPCS “PO” modifier with every code on facility claims for outpatient hospital services furnished in off-campus provider-based departments. Reporting will be voluntary for CY 2015, mandatory reporting will start January 1, 2016.
The question I am receiving from hospital providers is does this final rule and the mandatory use of the PO modifier beginning January 1, 2016 apply to outpatient therapy services that are furnished in off-campus facilities? The answer is
The content here is for members only log in here or sign up.
All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.
This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.
Does this include Critical Access Hospitals?
Critical access hospitals are reimbursed on a cost-ratio basis and not under OPPS.
Will the Place of Service code change from 22 to 19 for outpatient therapy “off campus”? and how is off campus defined? will the definition be payer specific?
CMS has defined off-campus and can be found in the CMS regulations.