Decoding Device Billing Under OPPS For Hospitals
                     Decoding Device Billing Under OPPS For Hospitals
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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.
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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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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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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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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.
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