CAHs This is a huge billing change in 2014!

This code does not apply to CAHs (for now).

This is a huge billing change in 2014! CMS has implemented a policy to combine outpatient clinic evaluation and management visit codes into one APC. CMS finalized a policy that eliminated the existing five levels of hospital outpatient clinic visit codes for both new and established patients and replaced them with a new HCPCS code (G0463) that will represent a single level of payment for all hospital outpatient clinic visits. The new HCPCS code will apply to all outpatient clinic visits (except emergency room visits) paid under the OPPS regardless of the level of effort and regardless of whether the patient is a new or established patient. Effective January 1, 2014, CMS will no longer recognize CPT codes 99201 through 99205 (new patient clinic visits) and 99211 through 99215 (established patient clinic visits) under the OPPS. 

CMS stated that this new system will reduce the hospital’s administrative burden and will be easy to adopt and comply with. For example, this new policy will eliminate the need for hospitals to develop and apply their own internal guidelines to differentiate between levels of clinic visits. It is also in line with CMS’s goal of using large payment bundles to incentivize hospitals to provide care in more efficient manners. CMS did not finalize its proposal to replace the current five levels of codes for emergency department visits but is considering options to improve codes for these services in future rulemaking.

Since OPPS (Outpatient Prospective Payment System) does not apply to Critical Access Hospitals, this new rule does not affect them.

Here is a link to the CMS regulation,

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