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Outpatient Prospective Payment System (OPPS)

The OPPS was implemented in 2000 and significantly changes how hospitals are reimbursed for outpatient services under Medicare.

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


Last Updated Apr 13, 2017