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US · guidance

CMS Pub. 100-04, ch. 4, § 20.2

Applicability of OPPS to Specific HCPCS Codes

activein force · 2026-08-25 – presentas-observed

The CPT codes generally are created to describe and report physician services, but are

also used by other providers/suppliers to describe and report services that they provide.

Therefore, the CPT code descriptors do not necessarily reflect the facility component of a

service furnished by the hospital. Some CPT code descriptors include reference to a

physician performing a service. For OPPS purposes, unless indicated otherwise, the

usage of the term "physician" does not restrict the reporting of the code or application of

related policies to physicians only, but applies to all practitioners, hospitals, providers, or

suppliers eligible to bill the relevant CPT codes pursuant to applicable portions of the

Social Security Act (SSA) of 1965, the Code of Federal Regulations (CFR), and

Medicare rules. In cases where there are separate codes for the technical component,

professional component, and/or complete procedure, hospitals should report the code that

represents the technical component for their facility services. If there is no separate

technical component code for the service, hospitals should report the code that represents

the complete procedure. Tables describing the treatment of HCPCS codes for OPPS are

published in the Federal Register annually.

History

(Rev. 1536, Issued: 06-19-08; Effective: 07-01-08; Implementation: 07-07-08)

Provenance

Source
cms.gov
Retrieved
2026-08-25
Edition
iom-2026-08-25
Content hash
cd318bd39299e6ebbe23a783702b0132c4c3b196967f9dd1f7dec8214a31416a
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