CMS Pub. 100-04, ch. 4, § 20.6.7

CA: Procedure payable only in the inpatient setting when performed emergently on

an outpatient who expires prior to admission

In the CY 2003 OPPS final rule (67 FR 66799), we discussed the creation of the new

HCPCS modifier CA to address situations where a procedure on the OPPS inpatient-only

list must be performed to resuscitate or stabilize a patient (whose status is that of an

outpatient) with an emergent, life-threatening condition, and the patient dies before being

admitted as an inpatient. HCPCS modifier CA is defined as a procedure payable only in

the inpatient setting when performed emergently on an outpatient who expires prior to

admission. In section VI of Transmittal A–02–129, issued on January 3, 2003, we

instructed hospitals on the use of this modifier. Transmittal A-02-129 is available on the

cms.gov website. For a complete description of the history of the policy and the

development of the payment methodology for these services, refer to the CY 2004 OPPS

final rule (68 FR 63467 through 63468), CY 2005 OPPS Final Rule (69 FR 65841), CY

2007 OPPS final rule (71 FR 68157 through 68158), and CY 2012 OPPS/ASC final rule

(76 FR 74153 through 74154).