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2025 HCPCS code PN

Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital.

Modifier PN must be appended to each HCPCS code for all outpatient hospital items and services furnished in a non-excepted off-campus, provider-based department of a hospital.Do not append modifier PN to excepted items and services.

Other modifiers may be applicable in addition to PN depending on the specific service provided. For drug and biologicals acquired with the 340B drug pricing program, JG modifier must also be reported.

Medical necessity guidelines are the same as for the underlying service provided.The PN modifier affects the payment rate, not the medical necessity requirements.

IMPORTANT:Use modifier PO for excepted services at an off-campus, outpatient, provider-based department.

In simple words: This code indicates that the service you received at a hospital-owned clinic that is not located on the main hospital campus is billed differently by Medicare and may result in a different out-of-pocket expense for you.

This modifier is used to identify non-excepted items and services provided at an off-campus, outpatient, provider-based department of a hospital, which are billed under the Medicare Physician Fee Schedule (MPFS).These services are generally reimbursed at a lower rate than services provided in the main hospital setting. The PN modifier is reported on each claim line with the relevant HCPCS code.

Example 1: A patient receives an X-ray at a hospital-owned outpatient clinic that is not on the hospital's main campus. The clinic is considered a non-excepted off-campus provider-based department. The X-ray service would be billed with the appropriate HCPCS code along with modifier PN., A patient undergoes a minor surgical procedure at a hospital-owned ambulatory surgery center that is located off-campus and considered non-excepted. The surgical procedure code is billed with modifier PN., A patient receives physical therapy services at a hospital-owned rehabilitation clinic that is off-campus and considered non-excepted. The therapy service is billed with the appropriate HCPCS code and modifier PN.

Documentation should clearly indicate that the service was provided at a non-excepted, off-campus, provider-based department of the hospital.The location of the service should be clearly stated in the medical record.

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