Modifier PN

20.6.12 - Modifier PN (Rev. 12552; Issued:03-21-24; Effective:04-01-24; Implementation:04-01-24) PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital A. General In accordance with Section 1833(t)(21) of the Act, as added by section 603 of the Bipartisan Budget Act of 2015 (Pub. L. 114-74), CMS established modifier PN to identify and pay nonexcepted items and services billed on an institutional claim. Effective January 1, 2017, non-excepted off-campus provider-based departments of a hospital are required to report this modifier on each claim line for non-excepted items and services. The use of modifier PN will trigger a payment rate under the Medicare Physician Fee Schedule (PFS). This modifier must be reported with each nonexcepted item and service including those for which payment will not be adjusted, such as separately payable drugs, clinical laboratory tests, and therapy services. Nonexcepted items and services are described in the regulations at 42 CFR 419.48. Off-campus provider-based departments should not report both the PO and PN modifiers on the same claim line. However, if services reported on a claim reflect items and services furnished from both an excepted and a nonexcepted off-campus PBD of the hospital, the PO modifier should be used on the excepted claim lines and the PN modifier should be used on the nonexcepted claim lines. Neither the PO nor the PN modifier is to be reported by the following hospital departments: • A dedicated emergency department as defined in existing regulations at 42 CFR 489.24(b); • A PBD that is “on the campus,” or within 250 yards, of the hospital or a remote location of the hospital as defined under 42 CFR 413.65. B. Effect on Payment Payment for nonexcepted items and services furnished at nonexcepted off-campus provider-based departments reported with modifier PN will result in a payment rate under the PFS effective January 1, 2017. The PN modifier is required to be reported on each claim line with each nonexcepted item and service including those for which payment will not be adjusted, such as separately payable drugs, clinical laboratory tests, and therapy services. C. Payment for Intensive Cardiac Rehabilitation (ICR) Services Effective January 1, 2024, ICR services furnished by a nonexcepted off-campus provider- based department are excluded from the 40 percent PFS Relativity Adjuster policy. This exclusion has been implemented at the code level. Specifically, the claims processing of HCPCS codes G0422 (Intensive cardiac rehabilitation; with or without continuous ECG monitoring with exercise, per session) and G0423 (Intensive cardiac rehabilitation; with or without continuous ECG monitoring without exercise, per session) have been modified so that 100 percent of the OPPS rate for Cardiac Rehabilitation (CR) is paid irrespective of the presence of the PN modifier on the claim.