October 2020 Update of the Hospital OPPS - Revised

MLN Matters Number: MM11960 Revised
Related CR Release Date: September 24, 2020
Related CR Transmittal Number: R10373CP
Related Change Request (CR) Number: 11960
Effective Date: October 1, 2020
Implementation Date: October 5, 2020

Note: CMS revised this article to reflect an updated CR 11960 that made a number of changes including:

  1. Added a new COVID-19 CPT code, 86413, to Table 1
  2. Added new Section 2: "New Category I CPT code 99072 for Reporting of Additional Practice Expenses Incurred During a Public Health Emergency (PHE), Including Supplies and Additional Clinical Staff Time."
  3. Added new Table 2, with the new 99072 CPT code.
  4. Re-numbered all sections after Section 2 and all the tables following Table 2.
  5. Added a new Sub-section e. to Section 8: "Drugs, Biologicals, and Radiopharmaceuticals."
  6. Added New Table 12 to describe these changes. All sub-sections following new Sub-section e. were re-numbered.
  7. Updated Sub-section g. and Table 14 to reflect the change to the long descriptor for HCPCS, C9066.
  8. Updated Tables 8 and 13 to reflect the correct long descriptor for C9066.

The CR release date, transmittal number and link to the transmittal was also changed. All other information remains the same.

CR 11960 informs you about the changes to and billing instructions for various payment policies implemented in the October 2020 Outpatient Prospective Payment System (OPPS) update. The October 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 11960. The October 2020 revisions to I/OCE data files, instructions, and specifications are provided in the forthcoming October 2020 I/OCE CR. Make sure that your billing staffs are aware of these changes.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)11960.


            Last Updated Tue, 29 Sep 2020 14:29:12 +0000