Definitions: Composite APCs provide a single payment for a comprehensive diagnostic and/or treatment service that is typically reported with multiple HCPCS codes. When HCPCS codes that meet the criteria for payment of the composite APC are billed on the same date of service, a single payment is made for all of the codes as a whole, rather than paying each code individually. The grouping process is described in the CMS Internet-Only Manual (IOM) Pub. 100-04, Chapter 4, Section 10.2.1 Use of the comment indicator “CH” in association with a composite APC indicates that the configuration of the composite APC has been changed for CY 2015.
Disclaimer
The information provided herein was current at the time of this communication. Medicare policy changes frequently so links to the source documents have been provided within the document for your reference. The opinions referenced are those of the members of the ATS Clinical Practice Committee and their consultants based on their coding experience. They are based on the commonly used codes in pulmonary, sleep and the critical care sections in CPT and HCPCS level II, which are not all inclusive. Always check with your local insurance carriers as policies vary by region. The final decision for the coding of a procedure must be made by the physician considering regulations of insurance carriers and any local, state or federal laws that apply to the physicians practice. The ATS and its representatives disclaim any liability arising from the use of these opinions. ®CPT is a registered trademark of the American Medical Association, CPT only copyright 2014 American Medical Association.
Table note: The final and interim final RVUs values listed in the table are set for 2015. However, the conversion factor of $35.7547 is for January 1, 2015 – March 31, 2015 only. The conversion factor for reminder of 2015 is unknown and is dependent on how Congress addresses the SGR fix.
