Earlier this year, two program memoranda (PM), were issued by the Centers for Medicare and Medicaid Services (CMS) Transmittal A-01-145 and Transmittal A-01-150 informing hospitals of a delay in the implementation of the 2002 Outpatient Prospective Payment System (OPPS) updates.
Facilities were instructed not to submit claims for OPPS services utilizing any of the new 2002 HCPCS codes during the delay. Per the instructions during the delay only HCPCS 2001 codes and modifiers were allowed for the billing of OPPS services.
Now as a result of the delay CMS has issued Program Memorandum, Transmittal A-02-026 outlining special billing requirements that apply for services furnished on or after January 1, 2002 through March 31, 2002.
The special requirements affecting the billing and coding for services provided on or after January 1, 2002 through March 31, 2002 payable under OPPS are as follows:
- Hospitals are to use the same HCPCS codes and modifiers used during 2001 for services furnished on or after January 1, 2002 through March 31, 2002 that are paid under the OPPS. Hospitals must also use HCPCS 2001 codes and modifiers that most closely describe the services provided in order to receive payment for services provided that were not covered under OPPS in 2001, but are covered in 2002.
- Hospitals paid under the OPPS should not use 2002 HCPCS codes or modifiers to bill for services provided on or after January 1, 2002 through March 31, 2002.
- Claims submitted containing any new HCPCS codes or modifiers for dates of service before April 1, 2002 will be returned unprocessed to the provider.
- Change requests (CRs) issued prior to December 21, 2001, that reflect a January 1, 2002 effective date for new 2002 codes payable under the OPPS, are effective April 1, 2002, for hospitals.
- Retroactive payment will not be made for new 2002 codes for services furnished prior to April 1, 2002.
- Claims for outpatient services with dates of service prior to April 1, 2002, using new 2002 codes will not be reprocessed.