Description
Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within three days.

Guidelines/Instructions
Certain diagnostic services, furnished to Medicare beneficiaries during the three days preceding an inpatient admission are considered operating costs of inpatient hospital services and are included in payment made to the hospital under the Hospital Inpatient Prospective Payment System (IPPS).

  • Under this rule, the hospital (or an entity that is wholly owned or wholly operated by the hospital) must include the technical portion of all outpatient diagnostic services and admission-related diagnostic services provided during the three-day payment window on the inpatient claim (and not on the Part B claim)
    • The professional components of these services may still be submitted to Part B
    • Submit HCPCS modifier PD with claims for the technical components of these diagnostic services
    • Submit HCPCS modifier PD with claims for all services that are related to the inpatient admission
  • Services provided by physicians that are not diagnostic services that are unrelated to the hospital admission are not subject to the three-day payment window. Do not submit HCPCS modifier PD with these services.

Reference

Contact Palmetto GBA JJ Part B Medicare

Provider Contact Center: 877-567-7271

Email JJ Part B

Contact a specific JJ Part B department



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