CMS provided examples of how to report service facility addresses under different circumstances in an MLN Matters.[1]
|
No. |
Service Facility |
Billing Provider |
Service Facility Address |
Modifier Used |
|---|---|---|---|---|
|
1 |
Billing provider (Main Campus) Only |
Yes |
N/A |
No “PO” or “PN” Modifier required on billing provider services. |
|
2 |
Billing Provider (Main Campus), Excepted Off-Campus |
Yes |
N/A |
No “PO” or “PN” Modifier required on Main Campus services. Modifier “PO” required on services with a HCPCS from Excepted Off-Campus. |
|
3 |
Billing Provider (Main Campus), Non-Excepted Off-Campus |
Yes |
N/A |
No “PO” or “PN” Modifier required on Main Campus services. Modifier “PN” required on services with a HCPCS from Non-Excepted Off-Campus. |
|
4 |
Billing Provider (Main Campus), Campus of Multi-Campus provider* |
Yes |
N/A |
No “PO” or “PN” Modifier required on billing provider services or other Campus services of a Multi-Campus. |
|
5 |
Campus of Multi-Campus provider* |
Yes |
Yes Campus Address* |
No “PO” or “PN” Modifier required on billing Campus services of a Multi-Campus. |
|
6 |
Billing Provider (Main Campus), Excepted Off-Campus, Non-Excepted Off-Campus |
Yes |
N/A |
No “PO” or “PN” Modifier required on Billing Provider services. Modifier “PO” required on services with a HCPCS from Excepted Off-Campus. Modifier “PN” required on services with a HCPCS from Non-Excepted Off-Campus. |
|
7 |
Billing Provider (Main Campus), Campus of Multi-Campus provider*, Excepted Off-Campus, Non-Excepted Off-Campus |
Yes |
N/A |
No “PO” or “PN” Modifier required on billing provider services or other Campus services of a Multi-Campus. Modifier “PO” required on services with a HCPCS from Excepted Off-Campus. Modifier “PN” required on services with a HCPCS from Non-Excepted Off-Campus. |
|
8 |
Campus of Multi-Campus provider*, Excepted Off-Campus, Non-Excepted Off-Campus |
Yes |
Yes Campus Address* |
No “PO” or “PN” Modifier required on billing Campus services of a Multi-Campus. Modifier “PO” required on services with a HCPCS from Excepted Off-Campus. Modifier “PN” required on services with a HCPCS from Non-Excepted Off-Campus. |
|
9 |
Excepted Off-Campus |
Yes |
Yes |
Modifier “PO” required on all services with a HCPCS. |
|
10 |
Non-Excepted Off-Campus |
Yes |
Yes |
Modifier “PN” required on all services with a HCPCS. |
|
11 |
Excepted Off-Campus, Non-Excepted Off-Campus |
Yes |
Yes First Registered Encounter |
Modifier “PO” required on services with a HCPCS from Excepted Off-Campus. Modifier “PN” required on services with a HCPCS from Non-Excepted Off-Campus. |
|
12 |
Excepted Off-Campus, Excepted Off-Campus |
Yes |
Yes First Registered Encounter |
Modifier “PO” required on all services with a HCPCS. |
|
13 |
Non-Excepted Off-Campus, Non-Excepted Off-Campus |
Yes |
Yes First Registered Encounter |
Modifier “PN” required on all services with a HCPCS. |
|
* Campus address is different from Billing Provider address; if the Campus address is the same as the Billing Provider address, follow the billing provider instructions. | ||||
