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New Edit for Prospective Payment System (PPS) Outpatient and Inpatient Bill Types Receiving an Outlier Payment When a Device Credit is Reported

The purpose of this Change Request (CR) is to implement editing to suspend Outpatient Prospective Payment System (OPPS) and Inpatient Prospective Payment System (IPPS) claims receiving an outlier payment when a device credit is reported. This new edit shall provide a mechanism for the Medicare Contractors to review the charges and device reduction amount submitted on the claim for fully or partially credited devices.

Download the Guidance Document


Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: July 07, 2022

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.