July 2020 Update of the Hospital OPPS - Revised

MLN Matters Number: MM11814 Revised
Related CR Release Date: July 15, 2020
Related CR Transmittal Number: R10224CP
Related Change Request (CR) Number: 11814
Effective Date: July 1, 2020
Implementation Date: July 6, 2020

Note: CMS revised this article on July 16. 2020, to reflect a revised CR 11814. In the article:

  • CMS updated the section on "Covid-19 Laboratory Tests and Services and Other Laboratory Tests Coding Update".
  • Table 1 has also been updated to add 3 new COVID-19 codes: 87426, 0223U, and 0224U.
  • CMS is also changing payment status indicator for HCPCS code Q5112 from SI=E2 to SI=K, effective April 15, 2020 through September 30, 2020 and are updating section 9 “Drugs, Biologicals, and Radiopharmaceuticals” by adding new subsections j and k to reflect this change.
  • Therefore, CMS is re-numbering all other subsequent sub-sections, and Tables 19 and 20 have been added to reflect payment status indicator change for Q5112. All other subsequent tables have been re-numbered.
  • CMS also revised the CR release date, transmittal number and the web address of the CR. All other information remains the same.

CR 11814 informs you about the changes to and billing instructions for various payment policies implemented in the July 2020 Outpatient Prospective Payment System (OPPS) update. The July 2020 Integrated Outpatient Code Editor (I/OCE) will reflect the HCPCS, Ambulatory Payment Classification (APC), HCPCS Modifier, and Revenue Code additions, changes and deletions identified in CR 11814. The July 2020 revisions to I/OCE data files, instructions, and specifications are provided in CR 11792. The article related to that CR, MM11792, is available at https://www.cms.gov/files/document/mm11792.pdf.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)11814.


            Last Updated Mon, 20 Jul 2020 14:20:34 +0000