Q&A: Modifiers -PN and -PO for Medicare Advantage, CAHs

Q. Will the -PO and -PN modifiers apply to Medicare Advantage? Critical access hospitals (CAH)?

A. Modifiers -PO and -PN would not apply to the services of a CAH. Modifier -PN serves to trigger an alternate payment system for otherwise OPPS payable services. Outpatient services at CAHs are not paid under the OPPS at all; therefore, modifier –PN, or -PO for that matter, would not apply to them.

As far as Medicare Advantage plans, the -PO and -PN modifiers are just modifiers that describe particular situations. Some of the Advantage plans will accept modifier -PO but it makes no payment difference. It’s up to the discretion of the plan.

Modifier -PN, arguably, would not apply to an Advantage plan. However, if you have a non-contracted Advantage plan, which would pay the Medicare rate, you would have to report it so they could calculate the rate correctly. In other words, modifier -PN is a rate modifier. It sets a rate. Contracted Medicare Advantage plans set their own rates; therefore, modifier -PN wouldn’t apply to contracted Medicare Advantage plans. However, when you have non-contracted plans, the non-contracted plans have the option of using the Medicare rate. They would not be able to correctly determine the Medicare rate without modifier -PN.

Editor’s note: This question was answered by Kimberly Anderwood Hoy Baker, JD, CPC, director of Medicare and compliance for HCPro.

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