US · guidance
CMS Pub. 100-04, ch. 3, § 20.4.9
Admission Prior to and Discharge After Capital PPS
Implementation Date
(Rev. 1, 10-01-03)
A3-3611.9
The capital payment issued for an inpatient hospital stay that begins prior to and ends after
the onset of capital PPS is the amount determined by Pricer for that DRG. No reasonable
cost capital pass through payment is payable for the portion of the stay that pre-dates capital
PPS. The A/B MAC (A) may not split a bill for the periods before and after the onset of
capital PPS that fall into the same billing period.
It bases any outlier payment due on the entire stay, not only that portion of the stay that
began after the start of capital PPS.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
22da965e43f8be97a5bc24c53fb01eb5fa6ba64167122b86056f2776be43b599
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