How are observation stays impacted by the TRICARE outpatient prospective payment system (OPPS)?
Observation stays of eight hours or more will be covered when provided in conjunction with direct admission to observation or a high level clinical or emergency department visit or critical care services. Low-dose-rate brachytherapy and cardiac electrophysiology evaluation and ablation will be paid using composite Ambulatory Payment Classifications (APCs) when the claim contains a specified combination of services. For those specific conditions that must be met to receive separate payment under the hospital OPPS, refer to the TRICARE Reimbursement Manual, Chapter 13 at http://manuals.tricare.osd.mil. Note: A separate maternity observation APC amount will be paid if an observation stay is for a minimum of four hours and accompanied with one of the required maternity diagnoses. The maternity observation APC is T0002 and is assigned to the Level II HCPCS observation codes G0378 and G0379.
Related Questions
- With the implementation of the Outpatient Perspective Payment System (OPPS), can a hospital-based Rural Health Clinic (RHC) bill for RHC services and non- RHC services on the same claim?
- With the implementation of the Outpatient Perspective Payment System (OPPS), can a hospital-based Rural Health Clinic (RHC) bill for RHC services and non-RHC services on the same claim?
- How does the department calculate payments for covered outpatient services through the outpatient prospective payment system (OPPS)?
