General Question for the Week of August 22, 2016

General Compliance Question of the Week

Question:

What kinds of services are appropriate for a “new technology” APC?

Answer:

New technology APCs are reserved for comprehensive services or procedures that are truly new and significant enough to warrant having a unique HCPCS code. They are intended to provide payment under the OPPS for complete services or procedures that cannot be appropriately reported by: 1) an existing HCPCS code assigned to a clinical APC or 2) a new HCPCS code that could be appropriately assigned to a clinical APC.

The most important criterion in determining whether a technology is “truly new,” according to the Centers for Medicare & Medicaid Services (CMS), is the inability to describe appropriately the complete service with a current individual HCPCS code or combination of codes.

For more on new technology APCs, see the document at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/newtechapc.pdf.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.