Hospital off-campus outpatient department enrollment requirements

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Home ► PE Tips and tutorials ► Hospital off-campus outpatient department enrollment requirements

Last Modified: 7/9/2025 Location: FL, PR, USVI Business: Part A

Hospital off-campus outpatient department enrollment requirements

Under Section 1833(t)(21) of the Social Security Act, providers must identify non-excepted services at an off-campus, outpatient, provider-based department of a hospital. Non-excepted services provided at an off-campus, outpatient, provider-based department of a hospital are paid under the Medicare physician fee schedule (MPFS), not the outpatient prospective payment system (OPPS) rates.

Claim edits were implemented to validate the location you are providing services is a Medicare-enrolled location. Providers should ensure their off-campus, outpatient departments are listed on their enrollment record. The location on your claim must match the location on your enrollment record location exactly.

To add a new or revise an existing location, complete a change of information enrollment application:

• Online through PECOS external link

• Or paper-based Medicare Enrollment Application - Institutional Providers (CMS-855A external pdf file

)

PECOS instructions for outpatient provider-based department (PBD)

• If you are a PBD site that provides services in hospital outpatient departments that are integrated with a hospital, select your Practice Location Type as Provider Based Department Site, and then select the appropriate PBD Type from the drop down on the application. It is imperative to provide the appropriate practice location type.

• Select OPT Extension Site for PBDs that provide only PT/OT/SLP therapy services

Note: Refer to the PECOS instructions for completing applications via PECOS

Paper instructions for outpatient provider-based department (PBD)

• In the Hospitals Only practice location section, there are selections to indicate your type of practice location. If you are a PBD site that provides services in hospital outpatient departments that are integrated with a hospital, mark your Practice Location Type as Outpatient Provider-Based Department (PBD) Site, and then mark the appropriate PBD type from the selections on the application. It is imperative to provide the appropriate practice location type

• Select Outpatient Physical Therapy Extension Site for PBDs that provide only PT/OT/SLP therapy services

• Hospitals are to select “Other Hospital Practice Location” and put “Mid-Build Exception” in the free form text field for paper 855As when the PBD record is for a hospital with an approved mid-build exception until the paper application is updated.

Note: If your organization is going through a change of ownership (CHOW), merger, or consolidation, the effective date of each practice location should reflect the date the location was established and not the date of sale.

To verify your enrolled, active practice locations:

• Access direct data entry (DDE): Provider practice address query - Option 1D

• Review current Medicare information on PECOS external link

• Call provider enrollment

For specific claim editing information, please visit:

• Activation of systematic validation edits for OPPS providers with multiple service locations

• MLN Matters article SE19007 external pdf file

, Activation of validation edits for providers with multiple service locations

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