CMS Pub. 100-04, ch. 4, § 170

Performed on the Same Day

(Rev. 12423; Issued: 12-20-23; Effective: 01-01-24; Implementation: 01-02-24)

When reporting a HCPCS code for a separately payable, non-repetitive hospital OPPS

service, report charges for all services and supplies associated with that service that

were furnished on the same date (services subject to the 3-day payment window are an

exception to this OPPS policy).

When a hospital provides electroconvulsive therapy (ECT) on the same day as partial

hospitalization or intensive outpatient services, both the ECT and partial

hospitalization or intensive outpatient services should be reported on the same hospital

claim. In this instance, the claim should contain condition code 41 for partial

hospitalization services or condition code 92 for intensive outpatient services. As

noted above, report charges for all services and supplies associated with the ECT

service that were furnished on the same date(s) on the same claim.

When a hospital provides non-partial hospitalization mental health services to a partial

hospitalization patient, all partial hospitalization services and non-partial

hospitalization mental health services should be reported on the same hospital claim

with condition code 41.

Likewise, when a hospital provides non-intensive outpatient program mental health

services to an intensive outpatient program patient, all intensive outpatient services

and non-intensive outpatient mental health services should be reported on the same

hospital claim with condition code 92.

NOTE: For a list of revenue codes that are considered repetitive services, see Chapter

1, §50.2.2.

EXAMPLE 1

If a patient receives a laboratory service on May 1st and has an emergency room (ER)

visit on the same day, one bill may be submitted since the laboratory service is paid

under the clinical diagnostic laboratory fee schedule and not subject to OPPS. In this

situation, the laboratory service was not related to the ER visit or done in conjunction

with the ER visit.

EXAMPLE 2

If the patient receives physical therapy on July 7th, 29th, and 30th, and receives

services in the ER on July 28th, the provider shall submit separate claims since the

isolated individual service (ER visit) did not occur on the same day as the repetitive

service (physical therapy).

EXAMPLE 3

If a patient has an ER visit (OPPS service) on May 15th and also receives a physical

therapy visit (repetitive, non-OPPS service) on the same day (as well as other physical

therapy visits provided May 1st through May 31st) the services shall be billed on

separate claims. The provider would bill the ER service on one claim and the therapy

services on the monthly repetitive claim. Please note, as stated above, the procedures

for billing repetitive services remains in effect under OPPS. Therefore, in this

example, it would not be appropriate to submit one therapy claim for services

provided May 1st through May 15th, a second claim for the ER visit provided on May

15th, and a third claim for therapy visits provided on May 16th through May 31st.

Providers shall not split repetitive services in mid-month when another outpatient

service occurs.

EXAMPLE 4

If a patient receives chemotherapy, or radiation therapy, clinical laboratory services, a

CT scan, and an outpatient consultation on the same date of service, the hospital may

report all services on the same claim or may submit multiple claims. Chemotherapy,

while commonly administered in multiple encounters across a span of time, is not a

repetitive service as defined in Chapter 1, Section 50.2.2. The clinical laboratory

services may be reported either on the single consolidated claim or on a separate claim

that reports the services furnished on the same date as the laboratory services.

EXAMPLE 5

If a partial hospitalization patient receives remote non-partial hospitalization mental

health services, the hospital should report all partial hospitalization services and non-partial hospitalization remote mental health services on the same claim. For each date

of service with partial hospitalization services (see section 260.1 of this chapter), at

least one of which is a partial hospitalization primary service, all partial

hospitalization services will be packaged under the appropriate hospital-based partial

hospitalization APC, 5863 or 5864. When APC 5863 or 5864 is assigned, all remote

non-partial hospitalization mental health services on the same date of service will be

packaged under APC 8010 with no additional payment. For any dates of service with

no partial hospitalization primary service, each remote non-partial hospitalization

mental health service will be paid at the corresponding APC payment rate or packaged

under the daily mental health composite APC 8010.