The July 2016 update to the Outpatient Prospective Payment System (OPPS) includes key changes to, and billing instructions for, various payment policies, as indicated in the 2016 OPPS final rule.
- The Centers for Medicare & Medicaid Services (CMS) revised Intensity Modulated Radiation Therapy (IMRT) planning billing instructions, per the 2016 OPPS final rule, effective July 1, 2016.
- CMS is also setting changes to the surgery section on “eye lift” surgery: Medicare does not allow separate payment for a blepharoplasty procedure, nor does CMS permit operating on the left and right eyes on different days when the standard of care is bilateral eyelid surgery.
- The update revises status indicators for Pathology CPT codes.
- Payments for drugs and biologicals based on the average sales price (ASP) are updated quarterly. Updated payment rates effective July 1 and drug price restatements are available in the July 2016 update of the OPPS Addendum A and B. Providers should resubmit claims affected by adjustments to previous quarter’s payment files.
These and other updates are available at AAPC’s website.