OPPS Update: 340B Drug Payment Adjustments for 2018-2022 Effective January 8, 2024
Source published November 8, 2023
What Changed The Hospital Outpatient Prospective Payment System (OPPS) will undergo adjustments effective January 8, 2024, as per the Federal Register Final Rule (Policy ID: FR-2023-24407). This updat
Action required by
January 8, 2024
Review the Action Required section below and ensure your team has completed all compliance steps before this date.
What Changed The Hospital Outpatient Prospective Payment System (OPPS) will undergo adjustments effective January 8, 2024, as per the Federal Register Final Rule (Policy ID: FR-2023-24407). This update addresses reimbursement rates for 340B-acquired drugs, correcting underpayment issues from 2018 to 2022. The rule aims to provide hospitals with appropriate compensation for outpatient services involving these drugs.
Why It Matters for Coding This change directly impacts claims submission and documentation for outpatient services involving 340B-acquired drugs. Coders need to be vigilant about how these adjustments affect CPT and HCPCS code selections, as these are likely to be influenced by the new payment rates. Accurate documentation of drug acquisition costs and patient treatment details will be crucial to align with the updated reimbursement structure.
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Content summarized from publicly available federal publications including CMS, MAC contractors, and the Federal Register. CLV Intelligence is not affiliated with or endorsed by any government agency. This is not legal or medical advice.