Does your hospital have off-campus facilities? If yes, then the insurance claims filed at these facilities need a special code for reimbursement. That code is the PO modifier. Without this modifier, all the claims submitted from that campus will be rejected. Which means it is very important to learn what this modifier is, when to use it, and how to use it to ensure clean claim submission.
Luckily, we have created this detailed guide on modifier PO. So together, let’s walk through everything you need to know.
PO Modifier – Description
The PO modifier is defined as:
“Services, procedures, and/or surgeries furnished at off-campus provider-based outpatient departments.”
Let’s look at a more elaborate description. In plain terms, this Healthcare Common Procedure Coding System (HCPCS) modifier tells Medicare that a service was delivered at a hospital’s outpatient, provider-based department (PBD), which is physically far from the hospital’s main campus.
In medical billing, this off-campus location is called “excepted” (or grandfathered). Appending this modifier is essential to the claims created at these facilities because the location changes the reimbursement amount.
What is important to note here is that the PO modifier is used exclusively for institutional claims that are submitted by hospitals, typically paid under the Outpatient Prospective Payment System (OPPS). You cannot append it to professional claims, since those are filed by individual physicians and reimbursed as per the Medicare Physician Fee Schedule (MPFS).
Here are the key things to note about this modifier:
- Claim Type: Institutional (facility) claims only, not professional claims.
- Applies To: Every HCPCS code billed for services at an excepted off-campus PBD.
- Mandatory For: All outpatient hospital items and services at those locations (CGS Medicare).
- Payment System: Services remain under OPPS, but with reimbursement reductions for certain codes.
Now that we have discussed what this modifier is, let’s clarify some key terms that we used in this description.
- Off-Campus: A department is considered off-campus when it is not located on the main hospital campus or is 250 yards away, in a remote location of the hospital.
- Provider-Based: Provider-based status is a Centers for Medicare and Medicaid Services (CMS) designation that allows a hospital to bill for facility services at an off-site location as if it were part of the hospital itself. Meaning, at rates higher than those of physician offices.
Appropriate Use Cases for PO Modifier
Knowing when to apply the PO modifier is just as important as knowing what it means. So, let’s look at a couple of real-world scenarios in which this modifier can be used:
Scenario 1
Suppose a 45-year-old patient with chronic knee pain visits an off-campus orthopedic clinic that is provider-based and “excepted” under the hospital’s outpatient department. The patient is treated with a therapeutic knee injection to manage inflammation and pain during the visit. The billing department appends the PO modifier to the procedure code when filling the Medicare institutional claim form.
Modifier PO signals to the payer that this service was rendered at an excepted off-campus provider-based department, making it eligible for the standard OPPS rate rather than a reduced payment rate.
Scenario 2
For this scenario, suppose a patient comes to a cardiology clinic. It is not an independent practice; it is a hospital-affiliated clinic. The hospital itself is located several miles away. The physician evaluates the patient’s condition and performs an echocardiogram.
The results seem normal, so the physician prescribes some basic medication to keep the heart healthy. After that, the billing department bills the services with appropriate billing codes and appends the PO modifier to them.
Accurate Usage Guidelines for PO Modifier
Let’s now discuss some additional guidelines that will help you use the PO modifier more accurately.
When to Use Modifier PO
- When the services are performed at a hospital-owned off-campus clinic, with a practice location.
- For all outpatient hospital services at an excepted off-campus PBD, including radiology, lab work, E/M visits, and surgical procedures.
When NOT to Use Modifier PO
- Remote locations of a hospital (as defined under 42 CFR 413.65(a)(2)).
- Satellite facilities of a hospital.
- Critical Access Hospitals (CAHs).
- On-campus locations within 250 yards of the main hospital or a remote location.
- Services billed on professional claims.
- Services furnished in emergency departments.
Additional Guidelines
- You must append the PO modifier to every HCPCS code on the claim for services furnished at an excepted off-campus PBD.
- Your claim must report the service facility address exactly as it appears in the CMS’s Provider Enrollment, Chain, and Ownership System (PECOS). This means that every space, character, punctuation mark, and other minor details must be the exact same.
PO vs PN Modifier
Below, we have included a table that summarizes the differences between the PO and PN modifiers.
| Feature | Modifier PO | Modifier PN |
|---|---|---|
| Full Description | Excepted service at off-campus, outpatient, provider-based department. | Non-excepted service at off-campus, outpatient, provider-based department. |
| Location Type | Excepted (grandfathered) PBD, billing under OPPS before Nov 2, 2015. | Non-excepted PBD, practice location effective date on or after Nov 2, 2015. |
| Payment System | OPPS (with applicable reductions). | Medicare Physician Fee Schedule (MPFS). |
Final Thoughts on PO Modifier
It is time to end this guide. But before that, let’s revisit the essential points that we discussed above.
- The PO modifier is used to bill services performed at a hospital’s outpatient department that is located at least 250 yards away from the main campus.
- The modifier is appended to all HCPCS codes.
- It is only appended to institutional claims.
- It helps the facility collect reimbursements at the standard OPPS rates.
The truth is, even with all the guidelines, medical billing is very challenging. Most in-house billing teams don’t have the experience and the expertise to match industry benchmarks. That’s why it is better to get professional medical billing and coding services from expert companies like NeuraBill. Trust us on this and notice the difference.
