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June 30, 2026

New Edit for Provider-Based Department Claims

This information applies to hospitals that operate an outpatient off-campus provider-based department (PBD).

Billing Requirement

Hospitals are required to report the:

  • Appropriate modifier with each claim line for a service provided at an outpatient off-campus PBD:
    • ER – Items and services furnished by a provider-based, off-campus emergency department
    • PO – Excepted service provided at an off-campus, outpatient, provider-based department of a hospital
    • PN – Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital
  • Service facility address (loop 2310E or Direct Data Entry (DDE) MAP 171F)

New Edit: Reason Code 34554

Effective for dates of service on or after July 1, 2026, type of bill (TOB) 13X or 14X claims will return to provider (RTP) with reason code 34554 when:

  • All claim lines contain modifier ER, PO, or PN.
  • The service facility address isn’t present.

See the CMS instructionExternal PDFfor details.

References

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