Federal (United States) · Agency guidance
Chapter 4
302 sections
302 sections
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10Hospital Outpatient Prospective Payment System (OPPS)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.1Background
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.1.1Payment Status Indicators
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.2APC Payment Groups
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.2.1Composite APCs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.2.2Cardiac Resynchronization Therapy
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.2.3Comprehensive APCs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.2.4Reporting for Certain Outpatient Department Services (That
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.3Calculation of APC Payment Rates
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.4Packaging
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.4.1Combinations of Packaged Services of Different Types That are
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.5Discounting
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6Payment Adjustments
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.1Payment Adjustment for Rural Sole Community Hospitals
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.2Payment Adjustment for Failure to Meet the Hospital
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.2.1Hospitals to Which the Payment Reduction Applies
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.2.2Services to which the Payment Reduction Applies
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.2.3Contractor Responsibilities
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.2.4Application of the Payment Reduction Factor in Calculation
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.3Payment Adjustment for Certain Cancer Hospitals
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.3.1Payment Adjustment for Certain Cancer Hospitals for CY
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.3.2Payment Adjustment for Certain Cancer Hospitals for CY
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.3.3Payment Adjustment for Certain Cancer Hospitals Beginning
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.3.4Payment Adjustment for Certain Cancer Hospitals Beginning
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.3.5Payment Adjustment for Certain Cancer Hospitals Beginning
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.3.6Payment Adjustment for Certain Cancer Hospitals Beginning
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.3.7Payment Adjustment for Certain Cancer Hospitals Beginning
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.3.8Payment Adjustment for Certain Cancer Hospitals Beginning
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.6.4Payment Adjustment for Rural Emergency Hospitals1
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.7Outliers
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.7.1Outlier Adjustments
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.7.2Outlier Reconciliation
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.7.2.1Identifying Hospitals and CMHCs Subject to Outlier
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.7.2.2Reconciling Outlier Payments for Hospitals and CMHCs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.7.2.3Time Value of Money
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.7.2.4Procedures for Medicare Contractors to Perform and Record
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.8Geographic Adjustments
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.8.1Wage Index Changes
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.9Updates
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.10Biweekly Interim Payments for Certain Hospital Outpatient
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11Calculation of Overall Cost-to-Charge Ratios (CCRs) for
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.1Requirement to Calculate CCRs for Hospitals Paid under
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.2Circumstances in Which CCRs are Used
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.3Selection of the CCR to be Used
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.3.1CMS Specification of Alternative CCR
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.3.2Hospital or CMHC Request for Use of a Different CCR
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.3.3Notification to Hospitals Paid Under the OPPS of a Change
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.4Use of CCRs in Mergers, Acquisitions, Other Ownership
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.5New Providers and Providers with Cost Report Periods Less
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.6Substitution of Statewide CCRs for Extreme OPPS Hospital
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.7Methodology for Calculation of Hospital Overall CCR for
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.7.1Methodology for Calculation of Hospital Overall CCR for
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.8Methodology for Calculation of Hospital Overall CCR for
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.8.1Methodology for Calculation of Hospital Overall CCR for
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.9Methodology for Calculation of CCR for CMHCs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.10Location of Statewide CCRs, Tolerances for Use of Statewide
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.11.11Reporting of CCRs for Hospitals Paid Under OPPS and for
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 10.12Payment Window for Outpatient Services Treated as Inpatient
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20Reporting Hospital Outpatient Services Using Healthcare Common
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.1General
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.2Applicability of OPPS to Specific HCPCS Codes
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.3Line Item Dates of Service
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.4Reporting of Service Units
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.5Clarification of HCPCS Code to Revenue Code Reporting
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6Use of Modifiers
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.1Where to Report Modifiers on the Hospital Part B Claim
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.2Use of Modifiers -50, -LT, and -RT
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.3Modifiers -LT and -RT
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.4Modifiers 73 and 74
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.5Modifiers 76 and 77
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.6Modifiers for Radiology Services
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.7Modifier CA
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.9Modifier FB
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.10Modifier FC
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.11Modifier PO
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.12Modifier PN
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.13Modifier CT
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.14Modifier FX
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.15Modifier FY
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.16Modifier JG
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.17Modifier TB
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.18Modifier ER
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.6.19Modifier CG
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 20.7Billing of ‘C’ HCPCS Codes by Non-OPPS Providers
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 30OPPS Coinsurance
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 30.1Coinsurance Election
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 30.2Calculating the Medicare Payment Amount and Coinsurance
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 40Outpatient Code Editor (OCE)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 40.1Integrated OCE (July 2007 and Later)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 40.1.1Patient Status Code and Reason for Patient Visit for the
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 40.2Outpatient Prospective Payment System (OPPS) OCE (Prior to
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 40.2.1Patient Status Code and Reason for Patient Visit for the
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 40.3Non-OPPS OCE (Rejected Items and Processing Requirements
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 40.4Paying Claims Outside of the IOCE
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 40.4.1Requesting to Pay Claims Without IOCE Approval
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 40.4.2Procedures for Paying Claims Without Passing through the
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 40.5Transitional Pass-Throughs for Designated Drugs or Biologicals
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 50Outpatient Pricer
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 50.1Outpatient Provider Specific File
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 50.2Deductible Application