Q&A: Using modifier –PN for nonexcepted services
Q: We have an off-campus provider based department that is “non-excepted,” so we have to report modifier –PN (nonexcepted service provided at an off-campus outpatient, provider-based department of a hospital). Is that for just the services that would be paid under the OPPS if the department were “excepted”?
A: The -PN modifier should be reported on each claim line. The purpose of this modifier is two-fold:
- Identification of the nonexcepted services provided
- Trigger the payment rate under the Medicare Physician Fee Schedule
This modifier should also be reported on claims lines for separately payable drugs, clinical laboratory tests, and therapy services. However, the modifier does not trigger a payment adjustment for these services. These specific services are paid either at the same amount in a physician’s office (average sales price +plus6% for drugs) or under the same fee schedule for OPPS hospitals and physician offices.
Excepted outpatient provider-based departments should continue to report modifier -PO (services, procedures and/or surgeries provided at off-campus provider-based outpatient departments), which has been mandatory since January 1, 2016.
For more information, see Transmittal 3685.
Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question.
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