covered OPD services

(1) Amount of payment (A) In general With respect to covered OPD services (as defined in subparagraph (B)) furnished during a year beginning with 1999, the amount of payment under this part shall be determined under a prospective payment system established by the Secretary in accordance with this subsection. (B) Definition of covered OPD services For purposes of this subsection, the term “covered OPD services”— (i) means hospital outpatient services designated by the Secretary; (ii) subject to clause (iv), includes inpatient hospital services designated by the Secretary that are covered under this part and furnished to a hospital inpatient who (I) is entitled to benefits under part A but has exhausted benefits for inpatient hospital services during a spell of illness, or (II) is not so entitled; (iii) includes implantable items described in paragraph (3), (6), or (8) of section 1395x(s) of this title ; (iv) does not include any therapy services described in subsection (a)(8) or ambulance services, for which payment is made under a fee schedule described in section 1395m(k) of this title or section 1395m(l) of this title and does not include screening mammography (as defined in section 1395x(jj) of this title ), diagnostic mammography, or personalized prevention plan services (as defined in section 1395x(hhh)(1) of this title ); and (v) does not include applicable items and services (as defined in subparagraph (A) of paragraph (21)) that are furnished on or after January 1, 2017 , by an off-campus outpatient department of a provider (as defined in subparagraph (B) of such paragraph).


42 USC § 1395l(t)()(1)

Scoping language

For purposes of this subsection
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