General

For the Week of August 22, 2016

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

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.