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August 8, 2023

Reminder: OPPS Off-Campus Provider-Based Department Edits

On August 1, 2023, CGS was instructed to permanently activate the edits that validate outpatient off-campus provider department addresses submitted on claims against the service facility addresses reported on the CMS 855A Medicare Enrollment application/PECOS.

If your claim receives one of these return to provider (RTP) edits (reason code 34977, 34978, 34984, 34985, 34986 or 34987):

  • Review the address reported on the claim (DDE claim page 03 / MAP171F).
  • Use myCGS or Direct Data Entry (DDE Inquiry Option 1D) to access a list of service facility addresses on file for your facility’s NPI/PTAN.
  • If the address on the claim is not an EXACT match to the address in the myCGS or DDE query screen, make the necessary corrections, and F9 or resubmit the claim.
  • If the address on the claim is an EXACT match to the address in the myCGS or DDE query screen, report the appropriate modifier (ER, PN, PO) on all applicable service lines.
  • Submit an 855A enrollment application in PECOS if you identify:
    • A new practice location that’s not enrolled
    • An existing practice location address that changed (including termination)

For additional information, please reference the resources on the Browse by Facility Type – OPPS/CMHC page on our website.

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