AHA Coding Clinic® for HCPCS - 2021 Quarter 4; For Your Information
Updates to device offset from payment
n the October 2021 Update of the Hospital Outpatient Prospective Payment System (OPPS) (Transmittal 10997 dated September 16, 2021), the Center for Medicare and Medicaid Services (CMS) determined the device(s) in the category described by HCPCS code C1831 should always be reported with one of the primary Current Procedural Terminology (CPT) codes 22558 , 22586 , 22612 , 22630 , or 22633 and add-on code 22853 or 22854 . In the July 2021 Update of the Hospital Outpatient Prospective Payment System (OPPS) (Transmittal 10825, dated June 11, 2021), CMS stated that the device in the category described by HCPCS C1761 should always be reported...
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Article Overview
This article explains a CMS update affecting Hospital Outpatient Prospective Payment System (OPPS) device offset reporting. It is aimed at facility coders, hospital outpatient billing staff, and reimbursement professionals who need to understand which procedure code groupings CMS associates with two device categories and how that list changed in a later OPPS update. The article presents the affected device categories, the related CPT and HCPCS procedure codes, and the timing of the retroactive update.
Why This Topic Matters
Device offset policy can affect how outpatient claims are reported and reviewed under OPPS. Keeping current with CMS transmittals helps billing teams align reporting with the latest device-to-procedure associations and avoid downstream claim issues.
Article Sections
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CMS OPPS update for HCPCS C1831
Covers the OPPS update discussion for one HCPCS device category and the related procedure code groupings referenced by CMS. The section also indicates the update source and timing.
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CMS OPPS update for HCPCS C1761
Covers the OPPS update discussion for a second HCPCS device category and the associated procedure code groupings referenced in the later CMS notice. The section notes that the update changed the earlier list and was retroactive.
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Code table of device categories and corresponding procedures
Presents the tabular mapping of the device categories to the related CPT and HCPCS procedure code entries. This section organizes the codes and descriptors referenced in the article.
What You Will Learn
- How CMS updated OPPS guidance for selected device categories
- Which broad procedure code groupings are discussed for each device category
- What CMS transmittals and update periods are referenced
- How a retroactive update is presented in the article
- How the article organizes device-to-procedure reporting information
Who Should Read This
- Hospital outpatient coders
- Billing and reimbursement staff
- Revenue cycle professionals
- Compliance teams
- Health information management professionals
Codes Discussed
Modifiers Discussed
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