ASC Special Payment for OPPS Complexity-Adjusted C-APCS

Effective January 1, 2023, WSI has adopted Medicare’s new ASC payment policy for OPPS complexity adjusted C-APCs. A complexity adjustment will be applied to the payment rate for an eligible primary surgical procedure and packaged add-on code combination performed in an ASC setting. To qualify for the adjusted payment, a provider must bill Medicare’s new HCPCs C-codes when billing eligible code pairs. A list of these new codes may be found on Table 4 here.

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