The payments are calculated by multiplying the APCs relative weight by the OPPS conversion factor and then there is a minor adjustment for geographic location. The payment is divided into Medicare’s portion and patient co-pay. Co-pays vary between 20 and 40% of the APC payment rate.

What is separate APC payment?

G Pass-Through Drugs and Biologicals Paid under OPPS; separate APC payment includes pass-through amount. … N Items and Services Packaged into APC Rates Paid under OPPS; payment is packaged into payment for other services, including outliers. Therefore, there is no separate APC payment.

What are APC status indicators?

The ultrasound procedure had a status indicator of “Q1.” The disposable NPWT procedures had a status indicator of “T.” The “Q1” status indicator means the APC payment is packaged if the code is billed on the same claim as a HCPCS code with a status indicator of “S,” “T,” or “V.” The “T” status indicator means a …