Which services are excluded under the Hospital Outpatient Prospective Payment System?

Clinical lab services are excluded from the Hospital Outpatient Prospective Payment System (OPPS) because they are reimbursed under a separate payment system known as the Clinical Laboratory Fee Schedule (CLFS). This system is specifically designed to handle laboratory tests performed on specimens taken from patients. As a result, these services remain outside the scope of OPPS, which primarily focuses on outpatient hospital services, including surgical procedures, clinic visits, and radiology services.

In contrast, surgical procedures, clinic/emergency visits, and radiology/radiation therapy are considered outpatient services covered under OPPS. Each of these falls within the categories that the OPPS aims to reimburse, as they represent essential aspects of outpatient care within hospital settings. Therefore, understanding the distinctions between these services and their respective payment systems is crucial for navigating reimbursement practices in a hospital environment.