Understanding device billing under the OPPS (Outpatient Prospective Payment System) for hospitals is essential for accurate reimbursement.

1. Decoding Device Billing Under OPPS For Hospitals
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2. Decoding Device Billing Under OPPS For Hospitals
Medicare is one of the healthcare industry’s fastest-growing federal health-insurance programs. With so many patients
dependent on Medicare for outpatient services, hospital expenditures are constantly increasing. To cover so many Medicare
patients, this causes a financial imbalance in the hospital budget.
Keeping this in mind, CMS developed the Outpatient Prospective Payment System (OPPS) to monitor outpatient service
expenses better. This keeps hospitals from running into financial difficulties while delivering outpatient services to thousands
of Medicare beneficiaries.

3. Purpose of Decoding Device Billing:
● The OPPS permits CMS to pay hospitals an agreed-upon sum for Medicare outpatient services. This approach
dramatically improves CMS’s ability to foresee and manage programs. It should be noted that the OPPS system is
based on the Ambulatory Patient Classification (APC) methodology. To ensure the success of the OPPS, CMS
allocates HCPCS codes to APC, which are changed annually. All outpatient services and devices must be billed on a
UB-92 or successor claim form utilizing HCPCS codes. The HCPCS codes encompass all of the CPT codes. The CMS
assigns the rates in the APC system to make the billing and reimbursement procedure as simple as possible.
● Bill Types:
● The bill type is a code that indicates the type of bill (inpatient, outpatient, cancellations, adjustments, and late
charges). This three-position field must be filled out for all outpatient bills paid through the Outpatient Prospective
Payment System (OPPS).
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4. Device Billing Guidelines under OPPS
The following are the guidelines to be implemented while billing for the devices under Outpatient Prospective Payment System
(OPPS) by hospitals:
● Reporting Device Codes on Claims:
● Claims Editing:
If the provider reports one of the following modifiers with the procedure code, device modifications do not apply to the
selected procedure code:
When a procedure that ordinarily needs a device is halted, either before or after the administration of anesthesia if anesthesia
is required or at any point, if anesthesia is not needed, hospitals should report modifications 52, 73, or 74 as relevant. In these
circumstances, the device edits are not implemented.
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5. Get in Touch with 24/7 Medical Billing Services!
The ultimate aim of OPPS in medical billing is to reduce the disparities in outpatient service reimbursement among hospitals.
That’s why it is crucial to make sure that your hospitals decode devices and other billing accurately to enhance maximum
reimbursement. The most optimal and cost-effective alternative is outsourcing Outpatient Prospective Payment System
(OPPS) billing services to 24/7 Medical Billing Services.
Outsourcing OPPS services to such a medical billing company ensures that you have a team of skilled medical billers who are
familiar with the Medicare, OPPS, and APC systems. To avoid refused claims, these medical billers verify that there are no
errors on the UB-92 or successor claim forms.
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6. About us
We are a medical billing company that offers ‘24/7 Medical Billing Services’ and support physicians,
hospitals, medical institutions and group practices with our end to end medical billing solutions. We help you
earn more revenue with our quick and affordable services. Our customized Revenue Cycle Management
(RCM) solutions allow physicians to attract additional revenue and reduce administrative burden or losses.
Media Contact:
24/7 Medical Billing Services
28405 Osborn Road, Cleveland, OH 44140
Phone no / Fax : +1 888-502-0537
Email us: info@247medicalbillingservices.com
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