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- Outpatient Services for Registered Inpatients
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- Billing for FQHC MAO Plan Supplemental Payment (PPS Providers)
- Billing for Services Not Included in the FQHC Benefit
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- ESRD Facilities: Clarification for Providing Dialysis Services to Patients Acute Kidney Injury
- Federally Qualified Health Centers Behavioral Health Claims Job Aid
- Federally Qualified Health Centers Contracting with Medicare Advantage Plans
- Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid
- Answers to Common Fee-for-Time Compensation Arrangements Questions
- FQHC and Group Therapy Services Job Aid
- Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate
- Inhalation Treatment CPT 94640 – Billing Errors
- Immunization Roster Billing
- Nonphysician Practitioners Billing for Surgical Procedures
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- Proper Billing for Finger and Toe Procedures
- Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements
- Proper Use of Taxonomy Codes
- A/B Rebilling Facts
- Common Reciprocal Billing Questions and Answers
- Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
- Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims
- Reporting Multiple Qualifying Visits on the Same Date of Service for FQHC Reimbursement
- Unlisted and Not Otherwise Classified Procedure Codes
- What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy
- Fiscal Year/Calendar Year Claim Split
Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims
Table of Contents
- Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims
- Repetitive Services
- Repetitive Services Revenue Codes
- Do Not Confuse Recurring Services with Repetitive Services
- Billing Monthly Repetitive Services
- Related Content
Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims
CMS sets limits on the frequency of which particular services may be billed to Medicare. In an effort to lower the volume of submitted bills and to facilitate medical review, frequency limitations have been created to require monthly bill submission of repetitive Part B services.
Consolidating repetitive services into a single monthly claim reduces CMS processing costs for relatively small claims and in instances where bills are held for monthly review.
Note: The instructions in this subsection also apply to hospice services billed under Part A, though they do not apply to home health services.
Repetitive Services
Institutional providers rendering outpatient services to a Medicare beneficiary that are billed with any following revenue codes are defined as repetitive Part B services. Repetitive services are required to be billed monthly or at the conclusion of treatment.
Repetitive Services Revenue Codes
| Type of Service | Revenue Code(s) |
|---|---|
| DME Rental | 0290 – 0299 |
| Respiratory Therapy | 0410, 0412, 0419 |
| Physical Therapy | 0420 – 0429 |
| Occupational Therapy | 0430 – 0439 |
| Speech-Language Pathology | 0440 – 0449 |
| Skilled Nursing | 0550 – 0559 |
| Kidney Dialysis Treatments | 0820 – 0859 |
| Cardiac Rehabilitation Services | 0482, 0943 |
| Pulmonary Rehabilitation Services | 0948 |
Do Not Confuse Recurring Services with Repetitive Services
Recurring services are institutional outpatient services rendered to a Medicare beneficiary multiple times during a month that are not billed with one of the above identified revenue codes. For example, chemotherapy or radiation therapy services are often rendered multiple times during one month but are not defined as repetitive services for Medicare billing purposes.
Recurring services may billed per day, week or monthly at the discretion of the provider.
Billing Monthly Repetitive Services
Submit one monthly claim per Medicare beneficiary for all repetitive services rendered during one month.
When a Medicare beneficiary receives repetitive services and during the same month also receives inpatient care, outpatient surgery or other non-repetitive outpatient hospital services subject to OPPS, the services are billed as follows:
- One monthly claim is billed for all repetitive services
- Report OSC 74 on the monthly repetitive services claim to encompass any inpatient stay dates, date of outpatient surgery or outpatient hospital services subject to OPPS.
- Note: Report any items and/or services in support of the repetitive service on the monthly repetitive claim even if the revenue code(s) reported with those supported services are not on the repetitive revenue code list
- Supporting items and/or services are those needed specifically in the performance of the repetitive service; for examples, drugs
- Note: Report any items and/or services in support of the repetitive service on the monthly repetitive claim even if the revenue code(s) reported with those supported services are not on the repetitive revenue code list
- Report OSC 74 on the monthly repetitive services claim to encompass any inpatient stay dates, date of outpatient surgery or outpatient hospital services subject to OPPS.
- Separate claim(s) are billed for any inpatient stay, date of outpatient surgery or outpatient hospital services subject to OPPS
- Note: Non-repetitive OPPS services provided on the same day by a hospital may be billed on different claims, provided that all charges associated with each non-repetitive procedure or service being reported are billed on the same claim with the HCPCS code which describes that service
Related Content
- CMS Internet-Only Manual, Publication 100-04, Chapter 1
- Section 50.2 - Frequency of Billing for Providers
- Section 50.2.2 - Frequency of Billing for Providers Submitting Institutional Claims with Outpatient Services
- CMS Internet-Only Manual, Publication 100-04, Chapter 4
- Section 170 - Hospital and CMHC Reporting Requirements for Services Performed on the Same Day
- Section 290.5.3 - Billing and Payment for Observation Services Furnished Beginning January 1, 2016
Posted 6/21/2022