Modifiers affecting reimbursement
Place of Services (POS) Codes
Medicare Payment Systems
Acronyms
Medicare %s and $s
100

Bilateral Procedure

What is modifier 50?

100

Office

What is place of service code 11?

100

Medicare's Ambulatory Payment Classifications (APCs) are used to determine reimbursement of these services

What are outpatient hospital services?

100

CPT

What is Current Procedural Terminology?

100

% of MPFS Physician Assistants receive

What is 85%?

200

Multiple Procedures

What is modifier 51?

200

On Campus - Outpatient Hospital

What is POS code 22?

200

Short-term acute hospital inpatient stays are reimbursed based on this ICD-10 dependent patient classification scheme (multiplied by a base rate)

What is MS-DRG (or DRG)? 

200

DOS

What is Date of Service?

200

% of MPFS received by Assistant at Surgery

What is 16%?

300

Two surgeons

What is modifier 62?

300

Ambulatory Surgery Center

What is POS code 24?

300

The Medicare Physician Fee Schedule (MPFS) is based on regionally adjusted RVUs multiple by this 

What is the Medicare conversion factor? 

300

DMEPOS

What is Durable Medical Equipment, Prosthetics, Orthotics, and Supplies? 
300

these each receive one half of 125% of the MPFS 

What are co-surgeons?

400

Professional component

What is modifier 26?

400

Home 

What is POS code 12?

400

For Medicare, a skilled nursing facility reimbursement is based in large part on these classifications

What are Resource Utilization Groups (RUG)?

400

RBRVS

What is Resource Based Relative Value Scale?

400

$33.2875

What is the current Medicare conversion factor? (MPFS)

500

Medical direction of two, three, or four concurrent anesthesia procedures

What is modifier QK?

500

Ambulance - Land (Ground)

What is POS code 41?

500

This is an example of a facility that Medicare reimburses based on cost

What is a Critical Access Hospital (CAH), a Cancer Hospital, or Children's Hospital? 

500

COBRA

What is the Consolidated Omnibus Budget Reconciliation Act of XXXX?  

Provide the year for a bonus! 

500

$6,497.77

What is the 2024 IPPS base rate? (Inpatient Prospective Payment System)

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