These services when billed on a UB04 are paid at 100% of usual and customary for CAHS and 100% of the professional fee schedule for acute care hospitals. Therapies are still subject to the professional multiple procedures discount for services performed on the same day by the same provider for both types of facilities. APC Reimbursement Levels Levels of APC reimbursement are different for ASCs than for hospitals. The basic formula for outpatient reimbursement is the base rate times the APC relative weight. Hospital outpatient base rate effective July 1, 2017 $114.00 ASC base rate effective July 1, 2017 $86.00 Outpatient Implants Implant cost refers to the total cost of all components for a patient. Providers must use the code MT003 to request implant reimbursements separate from the outpatient/APC fee schedule reimbursement. Implant invoices are not required for those services with a J1 or J2 status indicator in which the provider is not seeking additional reimbursement under MT003. Implants costing less than $500 are considered to be bundled into the APC reimbursement. Implants totaling more than $500 may be reimbursed at cost plus 15% A copy of the implant invoice is required with the medical bill for reimbursement. A copy of the surgical notes with the items implanted must be included in the documentation. Shipping and handling costs may be reimbursed at cost only and are not included in the 15% calculation.
These services when billed on a UB04 are paid at 100% of usual and customary for CAHS and 100% of the professional fee schedule for acute care hospitals. Therapies are still subject to the professional multiple procedures discount for services performed on the same day by the same provider for both types of facilities. APC Reimbursement Levels Levels of APC reimbursement are different for ASCs than for hospitals. The basic formula for outpatient reimbursement is the base rate times the APC relative weight. Hospital outpatient base rate effective July 1, 2017 $114.00 ASC base rate effective July 1, 2017 $86.00 Outpatient Implants Implant cost refers to the total cost of all components for a patient. Providers must use the code MT003 to request implant reimbursements separate from the outpatient/APC fee schedule reimbursement. Implant invoices are not required for those services with a J1 or J2 status indicator in which the provider is not seeking additional reimbursement under MT003. Implants costing less than $500 are considered to be bundled into the APC reimbursement. Implants totaling more than $500 may be reimbursed at cost plus 15% A copy of the implant invoice is required with the medical bill for reimbursement. A copy of the surgical notes with the items implanted must be included in the documentation. Shipping and handling costs may be reimbursed at cost only and are not included in the 15% calculation.
FINAL%20Facility%20Fee%20Schedule%20Instruction%20Set%20FY%202018.docx