Respiratory Question for the Week of January 30, 2017

Question:

In the OPPS, I read about respiratory therapy services sometimes being “conditionally packaged.” What does this mean?

Answer:

Respiratory therapy services are “conditionally packaged” when they appear as ancillary to a primary service. In Addendum B of the 2017 outpatient prospective payment system (OPPS), they are assigned a status indicator of Q1, Q2, or Q3. When they are not ancillary to a primary service but provided on their own as an outpatient procedure, they are paid separately.

For 2017, Medicare will align the logic for the conditional packaging status indicators so that packaging would occur at the claim level (instead of based on the date of service). The revision is anticipated to help stabilize payments over time.