One Day Payment Window

This provision applies to hospitals excluded from IPPS. The hospitals and units that are excluded from IPPS are: psychiatric hospitals and units; inpatient rehabilitation facilities (IRF) and units; long term care hospitals (LTCH); children’s hospitals; and cancer hospitals.

Diagnostic services (including clinical diagnostic laboratory tests) provided to a beneficiary by the admitting hospital, or by an entity wholly owned or wholly operated by the admitting hospital (or by another entity under arrangements with the admitting hospital), within 1 day prior to and including the date of the benefi ciary’s admission are deemed to be inpatient services and included in the inpatient payment, unless there is no Part A coverage. 

Note: For hospitals and units excluded from IPPS, this provision applies only to services furnished within one day prior to and including the date of the benefi ciary’s admission. 

Critical Access Hospitals (CAHs) are not subject to the 3-day (nor 1-day) DRG payment window.  

Type of Admission or Visit Code

1  Emergency

2 Urgent

3 Elective

4 Newborn

5 Trauma Center

9 Information Not Available

Payer Codes No. Payer Code Description 

1               Medicaid 

2        Blue Cross 

3           Other 

4             None 

A        Working Aged (Value Code 12) 

B          ESRD beneficiary in 30 month coordination period with EGHP (Value Code 13)

 C        Conditional Payment 

D           Auto no-fault (Value Code 14) 

E           Workers Comp (Value Code 15) 

F             Public Health or Federal Agency (Value Code 16)

G            Disabled (Value Code 43) 

H             Black Lung (Value Code 41) 

I                    Veterans Administration (Value Code 42)

L              Liability (Value Code 47) 

 Z                  Medicare 

Note: Payer codes 1 through 4 are used when the other payer is secondary. The alpha payer codes are used when the other payer is primary

Repetitive Services

Services repeated over a span of time and billed with the following revenue codes are defined as repetitive services. Repetitive services are required to be billed monthly or at the end of treatment. Any items and/or services in support of the repetitive service should be reported on the same claim (example: disposable supplies, drugs or equipment used to furnish the repetitive service).

Type of Service                 Revenue Code 

DME Rental                   0290 - 0299 

Respiratory Therapy   0410, 0412, 0419 

Physical Therapy           0420 - 0429 

Occupational Therapy    0430 - 0439 

Speech-Language Pathology 0440 - 0449 

Skilled Nursing                  0550 – 0559 

Kidney Dialysis Treatments 0820 - 0859 

Cardiac Rehab Services         0482, 0943 

Pulmonary Rehabilitation Services 948  

Note: Report occurrence span code 74 on the monthly repetitive service bill to encompass any inpatient stay dates, day of outpatient surgery, or outpatient hospital services subject to OPPS.

Note: If a non-repetitive OPPS service is provided on the same date of a repetitive service, report the nonrepetitive OPPS service (along with any packaged and/or services related to the non-repetitive service) on a separate OPPS claim.