Outpatient Prospective Payment System (OPPS) - JE Part A
Outpatient Prospective Payment System (OPPS)
The OPPS was implemented in 2000 and significantly changes how hospitals are reimbursed for outpatient services under Medicare.
Access the below OPPS related information from this page.
- Addendum A and B Instructions
- Chronic Care Management Services
- Enrollment
- OPPS Payment Status Indicators
Services Included Under OPPS
- Designated hospital outpatient services
- Certain Medicare Part B services furnished to hospital inpatients who do not have Part A coverage
- Partial hospitalization services furnished by hospitals or Community Mental Health Centers (CMHC)
- Hepatitis B vaccines and their administration, splints, casts, and antigens furnished by a Home Health Agency (HHA) to patients who are not under an HHA plan of treatment or to hospice patients for treatment of non-terminal illness
- An initial preventive physical examination (IPPE) performed within the first 12 months of Medicare Part B coverage
Services Excluded from Payment under OPPS
- Clinical diagnostic laboratory services
- Outpatient therapy services
- Screening and diagnostic mammography
Resources
- CMS Addendum A and B Updates - Updates reflect OPPS Pricer changes that are part of quarterly OPPS recurring update notification transmittals.
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 4 - Part B Hospital (Including Inpatient Hospital Part B and OPPS
- CMS OCE/Device Procedure Edits
- CMS OPPS National Correct Coding Edits
- CMS OPPS Guidance - Contains guidance related to OPPS policy transmittals, regulations, and notices
Last Updated Apr 12 , 2021
