CMS Pub. 100-04, ch. 4, § 20.6.18

ER: Items and services furnished by a provider-based, off-campus emergency

department

Effective January 1, 2019, hospitals were required to report HCPCS modifier ER on

every claim line that contains a CPT/HCPCS code for an outpatient hospital service

furnished in an off-campus provider-based emergency department. This modifier is

required to be reported in provider-based off-campus emergency departments that meet

the definition of a “dedicated emergency department” as defined in 42 Code of Federal

Regulations (CFR) 489.24 under the Emergency Medical Treatment and Labor Act

(EMTALA) regulations. Per 42 CFR 489.24, a “dedicated emergency department” means

any department or facility of the hospital, regardless of whether it is located on or off the

main hospital campus, that meets at least one of the following requirements:

(1) It is licensed by the State in which it is located under applicable State law as an

emergency room or emergency department;

(2) It is held out to the public (by name, posted signs, advertising, or other means) as a

place that provides care for emergency medical conditions on an urgent basis without

requiring a previously scheduled appointment; or

(3) During the calendar year immediately preceding the calendar year in which a

determination under 42 CFR 489.24 is being made, based on a representative sample of

patient visits that occurred during that calendar year, it provides at least one-third of all of

its outpatient visits for the treatment of emergency medical conditions on an urgent basis

without requiring a previously scheduled appointment.

This modifier would be reported on the UB–04 form (CMS Form 1450) for hospital

outpatient services. Reporting of this modifier is not required for Critical access hospitals

(CAHs). While this modifier is required, it does not have an effect on payment.