IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK ABOVE ON THE LINK LABELED "I Do Not Accept" AND EXIT FROM THIS COMPUTER SCREEN. BY CLICKING ABOVE ON THE LINK LABELED "I Accept", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THESE AGREEMENTS. THE LICENSES GRANTED HEREIN ARE EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THESE AGREEMENTS. If you choose not to accept the agreement, you will return to the Noridian Medicare home page. This includes items such as CPT codes, CDT codes, ICD-10 and other UB-04 codes.īefore you can enter the Noridian Medicare site, please read and accept an agreement to abide by the copyright rules regarding the information you find within this site. Some of the Provider information contained on the Noridian Medicare web site is copyrighted by the American Medical Association, the American Dental Association, and/or the American Hospital Association. This is indicated below in the screen image of in DDE. The APC is located in the PAY/HCPC APC CD field, and the payment rate is located in the PRICER AMT field. The status indicator will be located under the OCE FLAGS field number 1. Once the claim is selected type 02 in the CLAIM PAGE field and press F11 once. Providers that have access to Direct Data Entry (DDE) can view the status indicator, APC, or payment rate (if applicable) for an APC for a specific line on a claim after a claim is selected. Column G will list the National Unadjusted Copayment if applicable and Column H will list the Minimum Unadjusted Copayment if applicable.įinally, Column I indicates if a change has been made to any cell in the specific row. If the HCPCS code is paid on an APC, Column E will list the Relative Weight of the APC and Column F will list the Payment Rate of the APC. The OPPS payment status indicators (SI) can be found in Column C.Ĭolumn D lists the APC associated with the HCPCS code listed in column A, if the HCPCS code is paid under a separate APC payment. Column B lists a short description of the HCPCS code listed in Column A. Using Addendum BĪddendum B has nine separate columns, which is indicated below:Ĭolumn A lists the HCPCS codes paid under OPPS in numerical order, including codes that have been discontinued for the year. Note: APC information can be viewed in Addendum A. The quarterly updates of the Addendum's reflect the OPPS Pricer changes that are part of the quarterly OPPS recurring update notification transmittals from CMS. Information will include Healthcare Common Procedure Coding System (HCPCS) codes and their status indicators, Ambulatory Payment Classifications (APC) groups, and OPPS payment rates, which are in effect at the beginning of each quarter. Because a significant amount of surgical care takes place in hospital outpatient departments and ASCs, the ACS has a strong interest in CMS’ OPPS and ASC Payment System and the quality improvement efforts addressed in the OPPS/ASC rule.Facilities paid under OPPS utilize Addendum A and B to determine payments.Īddendum A and B are posted quarterly to the OPPS website. CMS updates the OPPS/ASC regulations together in one rule annually, with comment periods open prior to implementation of the final rule. This system for payment is called the ASC Payment System and is used when paying for covered surgical procedures, including ASC facility services that are furnished in connection with the covered surgical procedure. Payment for ambulatory surgical center (ASC) services is also based on rates set under Medicare Part B. The system for payment, known as the Outpatient Prospective Payment System (OPPS) is used when paying for services such as X rays, emergency department visits, and partial hospitalization services in hospital outpatient departments. Medicare payment for outpatient services provided in hospitals is based on set rates under Medicare Part B.
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