US · guidance

CMS Pub. 100-04, ch. 4, § 261.4

Reporting Service Units for Intensive Outpatient Program

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

Hospitals report the number of times the service or procedure, as defined by the HCPCS

code, was performed. CAHs report the number of times the revenue code visit was

performed.

EXAMPLE: A beneficiary received psychological testing (HCPCS code 96100 which is

defined in one-hour intervals) for a total of three hours during one day. The hospital

reports revenue code 0905 in FL 42, HCPCS code 96100 in FL 44, and three units in FL

46. The CAH would report revenue code 0918, leave HCPCS blanks, and report 1 unit in

FL 46.

When reporting service units for HCPCS codes where the definition of the procedure

does not include any reference to time (either in minutes, hours, or days), hospital

outpatient departments do not bill for sessions of less than 45 minutes.

The A/B MAC (A) must return to the provider claims other than CAH claims that do not

contain service units for each HCPCS code.

NOTE: Service units do not need to be reported for drugs and biologicals (Revenue

Code 0250).

Hospitals must retain documentation to support the medical necessity of each service

provided, including beginning and ending time.

History

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

Provenance

Source: cms.gov
Retrieved: 2026-08-25
Edition: iom-2026-08-25
Content hash: 2bbaa0d4d02f7d13b1b03ab39d1585f4ebe7863f228e48433f66e7c46fd387df

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