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Issue Number - Name
0072 - Outpatient Service Overlapping or During an Inpatient Stay
Review Type
Automated
Claim Type
Hospital Outpatient, Hospital Inpatient Part B
Region and State
RAC 1-4
All States
Date Approved
2017-10-05

Description

Payment may not be made for outpatient services overlapping or during an inpatient stay.

Affected Code(s)

  • No specific codes

Applicable Policy References

  • Title XVIII of the Social Security Act, Section 1833 (e)
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 1, Section 120.2 (A)
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 3, Section 40.3 B
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 4, Section 200.2
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 18, Section 10.2
  • CMS Pub. 100-06, Medicare Financial Management Manual, Chapter 3, Section 10.2 
  • CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, Section 10