Payment Method

11.3.4 – Payment Method (Rev. 11214, Issued: 01-20-22, Effective:04-13-21, Implementation: 01-03-22 Shared Systems Contractors, 02- 14-22 MACs) Payment for PRP services is as follows: • Hospital outpatient departments TOBs 12X and 13X – based on the Outpatient Prospective Payment System • Skilled Nursing Facility TOBs 22X and 23X – based on the Medicare Physician Fee Schedule (MPFS) • TOB 71X – based on the all-inclusive rate • TOB 75X – based on the MPFS • TOB 77X – based on the all-inclusive rate • TOB 85X – based on reasonable cost • Critical Access Hospitals TOB 85X and revenue codes 096X, 097X, or 098X – based on the MPFS Local MACs shall pay for PRP services for hospitals in Maryland under the jurisdiction of the Health Services Cost Review Commission on an outpatient basis, TOB 13X, in accordance with the terms of the Maryland waiver.