Frequently Asked Questions

Frequently Asked Questions are used to provide additional information and/or statutory guidance not found in State Medicaid Director Letters, State Health Official Letters, or CMCS Informational Bulletins. The different sets of FAQs as originally released can be accessed below.

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Can CMS provide a list of the revenue codes that are approved to be included in the outpatient hospital Upper Payment Limit (UPL) or conversely the revenue codes that cannot be included?

March 21, 2018

To date, CMS has not published a list of revenue codes that must be included or excluded from this service category. Medicaid outpatient hospital services are defined at 42 Code of Federal Regulations (CFR) 440.20 and include “preventive, diagnostic, therapeutic, rehabilitative, or palliative services”. In the state plan, states further define those services covered as outpatient hospital services.

FAQ ID:92411

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