2018 OPPS Key Highlights

How does the recently issued 2018 Medicare Physician Fee Schedule impact your organization?

Get to know the following key provisions:

Payment Rate Changes.

  • Off-Campus Provider-Based Departments: Except for dedicated emergency department services, services furnished in off-campus provider-based departments that began billing under OPPS on or after November 2, 2015, or that could not meet 21st Century Cures Act exception, will no longer be paid under OPPS – Result? Hospitals will receive payment of 40% of OPPS rate compared to current 50%.
  • 340B Drug Pricing Program: Separately payable, non pass-through drugs and biologicals (other than vaccines) purchased through 340B Program will be paid at average sales price MINUS 22.5% – Result? Currently, payment is average sales price PLUS 6% resulting in 28.5% payment swing. Exemptions for CY 2018: rural sole community hospitals, PPS-exempt cancer hospitals and children’s hospitals.

Covered Services.

  • Telehealth Services: Additional covered services/codes were added including: visit to determine low dose computed tomography; health risk assessment; care planning for chronic care management; psychotherapy for crisis.
  • Outpatient Therapeutic Services: Continuing non-enforcement of direct supervision requirements for outpatient therapeutic services for Critical Access Hospitals and small rural hospitals with less than 100 beds for CY2018 and 2019.
  • Inpatient Only List: Removing total knee arthroplasty and five additional procedures.


  • Ambulatory Surgical Center Quality Reporting: Removing three quality measures from 9 to 6 to more closely align with MIPS Scoring.
  • Hospital Outpatient Quality Reporting Program: Removal of following 6 measures:
  1. OP-2: Median time to pain management for long bone fracture
  2. OP-26: Hospital outpatient volume data on select outpatient surgical procedures
  3. OP-1: Median time to fibrinolysis
  4. OP-4: Aspirin at arrival
  5. OP-20: Door to diagnostic evaluation by qualified medical professional
  6. OP-25: Safe surgery checklist use


Recent Insights

Newsletter Sign-Up