-PO Excepted Services Provided at Off-Campus Provider-Based Outpatient Departments Modifier
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Defines UCare's billing and reimbursement rules for reporting the HCPCS -PO modifier for excepted services furnished at excepted off-campus provider-based outpatient departments; applies to all UCare products and providers billing UCare.
No material clinical or coverage changes in this revision.
Coverage and Billing Criteria for -PO Modifier
Coverage criteria for -PO modifier
UCare coverage and billing requirements for services using the -PO modifier:
Affected Codes and Reimbursement
| G0463 | Hospital outpatient clinic for assessment and management to a patient (when furnished in excepted off-campus provider-based department, append -PO) |
Billing and Reporting Requirements for Providers
-PO reporting and use
Report HCPCS modifier -PO on every HCPCS claim line for outpatient hospital items and services furnished in an excepted off-campus provider-based department; if a claim includes both excepted and non-excepted services, append -PO only on the excepted lines.
- Apply -PO on every HCPCS code for outpatient hospital items and services furnished in an excepted off-campus provider-based department.
- When a single claim contains both excepted and non-excepted off-campus provider-based department services, append -PO only to the excepted service lines.
Key Terms and Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.