Outpatient facility claims also report CPT® and HCPCS6
codes, which map to Ambulatory Payment Classifications (APCs), which
assign a Medicare hospital outpatient payment rate for the service. Depending upon the services provided, hospitals may
receive payment for more than one APC per patient encounter. If a claim contains services that result in an APC payment but
also contains packaged services, no separate payment for the packaged services will be provided, as these are included in the
APC. However, charges related to the packaged services are used for outlier and Transitional Corridor Payments (TOPs) as well as
for future rate setting. Therefore, it is extremely important that hospitals report all HCPCS codes consistent with their descriptors;
CPT® and/or CMS instructions and correct coding principles, and all charges for all services they furnish, whether payment for the
services is made separately or is packaged.
The C-codes below are reported by outpatient facilities for cases that involve drug-eluting stents. Please note that coronary
interventions of additional branches are bundled procedures, which will not be reimbursed under the Medicare physician fee
schedule or the HOPPS payment methodology.
Procedure Codes and Physician Reimbursement for Coronary Procedures
APC
|
Description
|
Status
Indicator
|
2017 Relative
Weight
|
2017 Medicare
Base Payment Rate
|
Diagnostic
Procedures and Imaging
|
||||
5181
|
Level
1 Vascular Procedures (code 93503)
|
T
|
9.1177
|
$684
|
5182
|
Level
2 Vascular Procedures (code 93505)
|
T
|
31.4609
|
$2,360
|
5188
|
Diagnostic
Cardiac Catheterization (codes 93451-93461, 93530- 93533)
|
J1
|
37.7643
|
$2,832
|
5192
|
Level
2 Endovascular Procedures (code 92920)
|
J1
|
64.3080
|
$4,823
|
5193
|
Level
2 Endovascular Procedures (code 92920)
|
J1
|
64.3080
|
$9,748
|
5194
|
Level
3 Endovascular Procedures (codes 92924, 92928, 92937, 92941, 92943, C9600,
C9604)
|
J1
|
129.9758
|
$14,776
|
5694
|
Level
4 Drug Administration (code 92977)
|
T
|
3.7243
|
$279
|
