Skip to Main Content

Print | Bookmark | Email | Font Size: + |

July 18, 2023

Important Update: OPPS Off-Campus Provider-Based Department Edits

On August 1, 2023, CGS will permanently activate Fiscal Intermediary Shared System (FISS) edits (reason codes) 34977, 34978, 34984, 34985, 34986 and 34987 in the J15 Kentucky and Ohio production regions. These edits were created to validate all outpatient off-campus provider department addresses submitted on claims against the service facility address reported on the CMS 855A Medicare Enrollment application/PECOS.

To avoid any return to provider (RTP) claims:

  1. Review SE19007External PDF for detailed information, including revisions issued on July 11, 2023.
  2. Use myCGS or Direct Data Entry (DDE Inquiry Option 1D) to identify/verify your facility’s service facility addresses on file.
  3. When you submit claims for services provided at an outpatient off-campus provider-based department:
    • Ensure the provider practice location address reported on the claim is an EXACT match to the service facility address on file.
    • Report the appropriate modifier (PN, PO, ER) on all applicable service lines.
  4. If you identify a new practice location that’s not enrolled or an existing practice location address that changed, submit an 855A enrollment application in PECOS.


26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved