CMS Pub. 100-04, ch. 4, § 240.5

Outpatient Services Treated as Inpatient Services When Payment

Cannot Be Made Under Part A

(Rev. 2877, Issued: 02-07-14, Effective: 10-01-13, Implementation: 04-07-14)

See Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, §10 (“Medical and Other

Health Services Furnished to Inpatients of Participating Hospitals”) and Pub 100-04,

Medicare Claims Processing Manual, Chapter 4, §10.12 (“Payment Window for

Outpatient Services Treated as Inpatient Services”) regarding services bundled into the

original Part A claim under the 3-day (1-day for non-IPPS hospitals) payment window

prior to the inpatient admission, that may be billed to Part B when Part A payment cannot

be made. Hospitals should use the following type of bill to report these services:

• 13X TOB (85X for a CAH)- Hospital outpatient services included in the payment

window for outpatient services treated as inpatient services

• 14X TOB- Laboratory tests that are paid under the clinical laboratory fee schedule

(see chapter 16, §40.3 of this manual), and included in the payment window for

outpatient services treated as inpatient services