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.

  1. 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.
  2. 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.
  3. The update revises status indicators for Pathology CPT codes.
  4. 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.