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CMS provided examples of how to report service facility addresses under different circumstances in MLN Matters (SE18002). Visit https://go.cms.gov/2VjMlVX.
| 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. | ||||