What Is APC Pricer?

APC Pricer© is an OPPS reimbursement calculator used to determine the expected reimbursement for outpatient hospital claims using CMS’s Outpatient Prospective Payment System (OPPS).* APC Pricer is simply an OPPS Pricer.

What is an APC code?

APC Codes (Ambulatory Payment Classifications)

APCs or Ambulatory Payment Classifications are the United States government’s method of paying for facility outpatient services for the Medicare (United States) program. APCs are an outpatient prospective payment system applicable only to hospitals.

What does separate APC payment mean?

Ambulatory Payment Classification. APC payments are made to hospitals when the Medicare outpatient is discharged from the Emergency Department or clinic or is transferred to another hospital (or other facility) which is not affiliated with the initial hospital where the patient received outpatient services.

What is the difference between DRG and APC?

DRGs have 497 groups, and APCs have 346 groups. APCs use only ICD-9-CM diagnoses and CPT-4 procedures. Payments for both are based on a weight for each DRG/APC and a rate for the facility. The unit of classification for DRGs is an admission while APCs utilize a visit.1 Apr 2000

What is composite APC payment?

Composite APC

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.