Healthcare News: CMS revises inpatient-only, preventive service lists in January 2020 OPPS update

Why This Topic Matters

It helps outpatient providers identify which CMS OPPS instructions were corrected or clarified in January 2020 and what broader billing and payment topics remain part of the update. This supports coding, billing, and compliance awareness for hospital outpatient services.

Article Sections

1. January 2020 OPPS transmittal update

   Overview of CMS rescinding one transmittal and replacing it with another to update outpatient prospective payment system guidance. The section notes that most of the original material remains unchanged.

2. Changes to the inpatient-only list for CY 2020

   Discussion of the revised language regarding procedures removed from the inpatient-only list for calendar year 2020. It references the related attachment where the affected procedures and outpatient payment information are listed.

3. Deductible and coinsurance correction for HCPCS code G0404

   Explanation of CMS adding corrected guidance related to preventive screening cost-sharing treatment in the outpatient setting. The section identifies a newly addressed preventive service billing issue.

4. Other OPPS topics retained in the transmittal

   Summary of the additional outpatient billing and payment topics that remain included in the updated guidance. These topics span devices, modifiers, skin substitutes, APCs, coverage, imaging, records, supervision, and wage-index policies.