General

General Question for the Week of May 25, 2020

General Compliance Question of the Week

Question:

Do the new Appropriate Use Criteria (AUC) modifiers and G codes have to be added to hospital claims as well as interpreting physician claims?

Answer:

Yes, this applies to outpatient hospitals and ASCs, as well as imaging centers, and physicians. Basically, the rule is applicable to anyone paid through the Hospital Outpatient Prospective Payment System (OPPS), Medicare Physician Fee Schedule (MPFS), or the Ambulatory Surgical Center (ASC) fee schedules. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Appropriate-Use-Criteria-Program/index.html

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