Awareness : OBC Tips

Off-Campus Provider-Based Department (PBD)

In an off-campus provider-based department (PBD) of a hospital, should the PO modifier be applied for drugs or laboratory services?

The determinative factor is whether or not the item or service is being paid through the OPPS.  If an item or service is being provided by an applicable provider and is being paid through the OPPS, then the POmodifier should be appended. For Example, a drug with an OPPS status indicator of “K” or a laboratory test that is packaged into an OPPS service should have the PO modifier appended. If a service is not paid through the OPPS, such as a laboratory test paid separately through the Clinical Laboratory Fee Schedule (CFLS), it should not have the PO modifier appended.

Note: The Medicare Claims Processing Manual Chapter 4 20.6.11 was updated in July 2015 to read: “This modifier is to be reported with every HCPCS code for all outpatient hospital items and services furnished in an off-campus provider-based department a hospital.”