CMS / Medicare / source directory

Hospital OPD bill-type boundary

This OPD program applies to hospital outpatient services billed as 13X. Other settings need their own program assessment, including the separate ASC demonstration. Scope: Program operations only; no individual coverage or medical-necessity determination. Source checked 2026-10-15. Documentary verification only; no clinical review or individual coverage determination.

Prior authorization: unknown. Member-specific applicability must be checked with the payer.

PayerCMS / Medicare

Plan contextOriginal Medicare — reference context only

ServiceHospital outpatient program

State scopeNot verified

Effective dateNot verified

RevisionSource 7a3c7f50705f

Retrieved10/15/2026

EvidenceOpen original source ↗

Source evidence

Documentary checks establish what the official source says, not clinical eligibility.

opd faq · PDF page 3 — source checked 2026-10-15

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This public reference is available in full above. Paid research tools are not currently available; no clinical checklist or cross-payer authorization determination is included.

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Evidence fingerprint: 7a3c7f50705f54f8db2123c1e9d95c2bf4c9c51acc2466e34ba87fd09fceff44