Description : Specialty Physician Provided Service (for determining Physician Scarcity Area (PSA) bonus).
Required for Claims : Critical Access Hospitals (CAHs) Electing the Optional Payment Method (Method II)
Type of Bill: 85X
Coding Guidelines : Applies to services rendered by a primary care physician (e.g. general practice,
family practice, internal medicine, OB/GYN)
General Guidelines : This modifier should be used only for critical access hospitals who elect the Method 2 outpatient payment methodology (All-inclusive rate) when the professional services are performed by primary care physician in a physician scarcity area (PSA) The reimbursement is a bonus payment that is separate from the claim payment. PSA payments are made quarterly.
Payment Implications : The CAH will receive 155% of 85% of the physician fee schedule for these services.
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