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