Learning about APC codes

[KathyB014]

This is new for me and I'm struggling to find basic resources. Does anyone have a good place to learn the basics of these codes? I'm can't even find a fee schedule lookup tool on CMS to see what these codes pay in the ASC.

 

[OpenClaims]

Here is the link to the Medicare Physician Fee Schedule Look-Up Tool: https://www.cms.gov/medicare/physician-fee-schedule/search.

 

[thomas7331]

This is new for me and I'm struggling to find basic resources. Does anyone have a good place to learn the basics of these codes? I'm can't even find a fee schedule lookup tool on CMS to see what these codes pay in the ASC.

The documentation for the OPPS payment system as applies to ASCs can be found on the CMS Medicare site here:

Ambulatory Surgical Center (ASC) Payment | CMS

Spotlights ASC Covered Procedures List (CPL) Nomination Process for CY 2023

www.cms.gov

There aren't really any published 'fee schedules' for facilities under Medicare payment systems. Theoretically you can determine your payment rates from the information on Medicare's sites if you understand the formulas and payment rules really well, but it's a bit of a complicated and manual process. In my experience, it's much easier if you purchase a software package or use an encoder that has this capability already programmed into it.