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Provider Notice issued 09/19/14
Hospital Rate Reform - Removing Inpatient-Only Procedures from the Ambulatory Procedures Listing (APL)
| To: | Enrolled Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers; and Ambulatory Surgical Treatment Centers (ASTCs) |
| Date: | September 19, 2014 |
| Re: | Hospital Rate Reform - Removing Inpatient-Only Procedures from the Ambulatory Procedures Listing (APL) |
This notice provides information regarding a significant change to the Ambulatory Procedures Listing (APL).
The 3M™ Enhanced Ambulatory Patient Groups (EAPG) payment system for outpatient claims is structured to identify certain surgical procedures that are payable only in the inpatient setting. If the EAPG grouper encounters one of these procedure codes on an outpatient claim, it will pay the revenue line at zero. The listing of inpatient-only procedure codes built into the EAPG grouper is the list published by the federal Centers for Medicare and Medicaid Services (CMS) for the Medicare Program. The inpatient-only list is published annually in the Federal Register as Addendum E to the Hospital Outpatient Prospective Payment System final rule, generally in December.
To be consistent with certain programmatic and reimbursement decisions previously made, the department has removed the CMS-designated inpatient-only procedure codes from the APL retroactive to July 1, 2014. The listing of HCPCS codes that have been removed from the APL is attached.
Any questions regarding this notice may be directed to the Bureau of Hospital and Provider Services at 1-877-782-5565.
Theresa A. Eagleson, Administrator
Division of Medical Programs