Outpatient Prospective Payment System (OPPS)
The OPPS was implemented in 2000 and significantly changes how hospitals are reimbursed for outpatient services under Medicare.
- Addendum A and B Instructions
- Addendum A and B Updates - Updates reflect the OPPS Pricer changes that are part of the quarterly OPPS recurring update notification transmittals.
- Chronic Care Management Services
- OPPS Payment Status Indicators
- OPPS National Correct Coding Edits
- OPPS Guidance - Contains guidance related to OPPS policy transmittals, regulations, and notices.
- Hospital Outpatient Prospective Payment System - Payment System Fact Sheet Series
- OCE/Device Procedure Edits
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