2025 HCPCS code PD
(Active) Effective Date: N/A Modifiers - Modifiers for HCPCS codes Feed
Diagnostic or related non-diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days.
Other modifiers may be applicable in addition to modifier PD, such as modifiers for the professional component (-26), technical component (-TC), etc.
Medical necessity for both the outpatient service and the inpatient admission must be established and documented separately.
The physician or provider is responsible for correctly appending the modifier when billing for services provided in a wholly owned or operated entity when the patient is admitted as an inpatient within 3 days.
In simple words: This code is used when a patient receives services at a facility owned and run by a hospital and is then admitted to the hospital as an inpatient within three days. It helps adjust the payment for those initial services since they are related to the hospital stay.
This modifier is used with HCPCS codes to report preadmission diagnostic and non-diagnostic services related to a subsequent inpatient admission.It applies when the entity providing the service is wholly owned or operated by the hospital and the patient becomes an inpatient within three days."Wholly owned" means the hospital is the sole owner, and "wholly operated" means the hospital has exclusive responsibility for the entity's routine operations.
Example 1: A patient presents to a hospital-owned urgent care with chest pain and receives an EKG (93000).The patient is admitted to the hospital for chest pain within 3 days. The EKG should be billed with modifier PD., A patient receives a pre-operative evaluation (99214) at a physician's office wholly operated by the hospital. The patient is admitted for surgery 2 days later.Modifier PD should be appended to the E/M code., A patient receives x-rays (71020) at a hospital-owned imaging center. One day later, the patient is admitted to the same hospital for a related condition.Modifier PD would be applied to the x-ray code.
Documentation should clearly indicate the relationship between the outpatient services and the reason for the inpatient admission. If the services are unrelated to the admission, this should be documented.
** If the entity providing the service is not wholly owned or operated by the hospital, do not append modifier PD.
- Payment Status: Active
- Modifier TC rule: If the service has a technical component, and the PD modifier applies, usually only the professional component is paid separately.
- Specialties:This modifier applies across multiple specialties.
- Place of Service:Office, "Off Campus-Outpatient Hospital", "On Campus-Outpatient Hospital", "Independent Clinic", "Federally Qualified Health Center", etc.