Tuesday, June 29, 2021

Very Brief Blog: CMS Prices Cat III Codes for OPPS (Outpatient) Setting, July 2021

 I don't always mention, but CMS issues frequent updates to hospital outpatient coding and pricing, as new codes are creating.  Sometimes these are worth tracking.  For example, CMS may place new CPT codes, especially new Category III CPT codes by crosswalking them to outpatient pricing tiers ("APC" pricing), well ahead of the time CMS Part B assigns conventional RVUs.

For example, in CR12316 here, CMS provides rapid APC pricing for Cat III codes 0640T-0670T.   Sometimes MACs find and use this APC pricing as an index towards their local pricing of Cat III codes.