2016 OPPS final rule introduces new modifiers and restructured APCs

Why This Topic Matters

These updates affect outpatient reporting workflows, modifier tracking, and APC assignment structures across several service lines. Understanding the rule’s scope helps facilities assess which policy changes may affect claims processing and charge capture.

Article Sections

1. Data collection modifier limited to one C-APC

   Discusses CMS’s approach to a new data collection modifier and the limited APC context in which it applies. Covers the general reporting scenario and operational concerns raised by commenters.

2. CMS adds modifier –CT

   Summarizes the introduction of a new CT-related modifier tied to equipment standards and effective dates. Describes the broad categories of CT services and the payment-policy context addressed in the article.

3. APC restructuring

   Reviews the broad APC regrouping finalized for multiple clinical families in the 2016 OPPS final rule. Highlights the general rationale CMS used for the restructuring and the service areas affected.