A recently published Program Memorandum (PM) Transmittal A-01-133, addresses packaged services under the outpatient prospective payment system (OPPS).
The purpose of this PM was to render advice on how to handle packaged services submitted on claims from hospital outpatient departments (bill types 12X, 13X, and 14X). The Centers for Medicare & Medicaid Services (CMS) felt that this PM was necessary because it was brought to their attention that hospital outpatient claims containing services that would be packaged services if an Ambulatory Payment Classification (APC) were payable, are not being properly handled.
Packaged services are items and services that are considered to be an integral part of another service that would be paid under the outpatient prospective payment system (OPPS). No separate payment is made for packaged services, because the cost of these items is included in the APC payment for the service of which they are an integral part.
For example: Routine supplies, anesthesia, recovery room and most drugs are considered to be an integral part of a surgical procedure so payment for these items is packaged into the APC payment for the surgical procedure.