Q&A: Medicare Advantage and provider-based department modifiers

Q: Do modifiers -PO and -PN apply to Medicare Advantage? Does modifier -PN apply to critical access hospitals (CAH)?

A: Modifier -PN would not apply to CAHs. It will only apply to the alternate payment system and provider-based department services that had been paid under the OPPS, but are no longer. CAH outpatient services are not paid under the OPPS. Therefore, modifier -PN, or modifier -PO for that matter, would not apply to CAHs. 

For Medicare Advantage plans, modifiers -PO and -PN are just modifiers that describe situations, particular situations, but the extent to which it will affect payment—if at all—is up to the individual plan.

For more information, see Evolving Reimbursement in On- and Off-Campus Provider-Based Departments.

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