July 2020 OPPS Update

CMS has issued their July 2020 update of the Hospital Outpatient Prospective Payment System (OPPS).  The update contains a number of notable items including:

  • COVID-19 laboratory tests, services and codes
  • Status indicator changes for certain virtual services
  • New telehealth codes for distant sites
  • 25 new CPT category III codes
  • Coding changes for CPT Proprietary Laboratory Analyses (PLA)
  • New HCPCS codes for certain drugs, biologicals, and radiopharmaceuticals receiving pass-through status as well as current codes with pass-through status changes
  • 42 new drug, biological and radiopharmaceutical HCPCS codes
  • Changes to supervision of outpatient therapeutic services

We recommend you read the complete update to understand the latest Medicare changes that impact your facility and update your charge description master (CDM) prior to the July 1 implementation date. 

A complete and accurate CDM is critical to ensure compliant reimbursement, optimal charge capture, avoid unnecessary denials and improve revenues.  

The July OPPS update can be accessed here: https://www.cms.gov/files/document/mm11814.pdf

HBE’s team of revenue cycle and compliance experts is available to assist you with external reviews of your CDM as well as providing customized education and training for your staff regarding the latest Medicare changes.  We are also available to provide assistance with conducting risk assessments, routine auditing and monitoring, and policy and procedure development.

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