Reason Code: 34986
Error Description:
The PN modifier is missing from one or more claim lines. Claim level reason code appliable to a 13X or 14X TOB. A practice location is present on the claim and matches to an entry on the Provider Practice Address Query Screen (MAP1AB2) in FISS DDE or PECOS. However, the PN modifier is not present on the claim.
Avoiding/Correcting This Error
The PN modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus outpatient, PBD of a hospital. The PN modifier applies to a grandfather/excepted PBD for DOS on/after 1/1/2017. Non-grandfathered means that the off-campus practice location has an effective date on or after 11/2/2015.
Please verify billing and, if appropriate correct by updating the PN modifier to the applicable claim line(s).
Online Providers: Press PF9 to store the claim.
Other Providers: Return to the MAC.
Related Content
- CMS Special Edition SE19007: Activation of Validation Edits for Providers with Multiple Service Locations
- URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations
- Attention All OPPS Providers: Provider-Based Department
- Learn more about the Provider Practice Address Query screen (1D) in the FISS DDE
- Instructions are included in our FISS DDE Provider Online Guide in Chapter IV: Inquiries Submenu (01) > Provider Practice Address Query (1D)