What Is Composite Apc Payment
A Composite Ambulatory Payment Classification (Apc) Is When a Single Payment Rate for a Service Which Is a Combination of Several Hcpcs Codes on the Same Date...
A composite ambulatory payment classification (APC) is when a single payment rate for a service which is a combination of several HCPCS codes on the same date of service (or a different date) for several major procedures.
How does APC pricing work?
The payments are calculated by multiplying the APCs relative weight by the OPPS conversion factor and then there is a minor adjustment for geographic location. The payment is divided into Medicare’s portion and patient co-pay. Co-pays vary between 20 and 40% of the APC payment rate.
What is the difference between CPT and APC codes?
Surgical, significant and ancillary APCs are assigned using only the CPT-4 procedure codes, while medical APCs are based on the combination of the ICD-9-CM diagnosis code and the E&M CPT-4 code. HCFA also considered defining medical APCs based only on diagnosis code or only on E&M code.
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