US · guidance
CMS Pub. 100-04, ch. 4, § 150
Hospitals That Do Not Provide Outpatient Services
HO-440.1, A-00-21, A-02-064
Covered Part B-only services furnished to inpatients when they are furnished by a
hospital that does no Medicare billing for hospital outpatients services under Part B are
excluded from OPPS. The Part B-only services, which are payable for hospital inpatients
who have either exhausted their Part A benefits or who are not entitled to Part A benefits,
are specified in Chapter 3. These services include, but are not limited to, diagnostic tests;
x-ray and radioactive isotope therapy; surgical dressings; limb braces and trusses; and
artificial limbs and eyes. Medicare payment for excluded Part B-only services furnished
by these hospitals is determined using the method under which the hospital was paid prior
to OPPS.
Hospitals must notify their A/B MAC (A) if they do not submit claims for outpatient Part
B services, so that their claims can be excluded from the OPPS. The hospital must also
notify the A/B MAC (A) if it begins to furnish Part B outpatient services. OPPS will
apply at that time unless other exclusions are applicable.
History
(Rev. 1, 10-03-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
aa9ad008bd7612c47934b480e353e30d2456e3c2d2df824350efe4fc5b002e6e
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