Outpatient Hospital Services

20 - Outpatient Hospital Services (Rev. 12425; Issued: 12-21-23: Effective: 01-01-24; Implementation: 01-02-24) Hospitals provide two distinct types of services to outpatients: services that are diagnostic in nature, and other services that aid the physician in the treatment of the patient. Part B covers both the diagnostic and the therapeutic services furnished by hospitals to outpatients. The rules in this section pertaining to the coverage of outpatient hospital services are not applicable to the following services. • Physical therapy, speech-language pathology or occupational therapy services when they are furnished “as therapy” meaning under a therapy plan of care. See chapter 15, sections 220 and 230 of this manual, for coverage and payment rules for these services, which are paid at the applicable amount under the physician fee schedule. • Services that are covered and paid under the End Stage Renal Disease Prospective Payment System. See Chapter 11, “End Stage Renal Disease (ESRD)” of this manual, for rules on the coverage of these services. For policies in addition to this section that apply to partial hospitalization services, see chapter 6, section 70.3 of this manual, and Pub. 100-04, Medicare Claims Processing Manual, chapter 4, section 260. For policies in addition to this section that apply to intensive outpatient services, see chapter 6, section 70.4 of this manual, and Pub. 100-04, Medicare Claims Processing Manual, chapter 4, section 261. For rules on the coverage of services and supplies furnished incident to a physician’s professional services in an office or physician-directed clinic setting, refer to Chapter 15, “Covered Medical and Other Health Services,” section 60 of this manual.