CMS adds complexity adjustments in July quarterly I/OCE update

Why This Topic Matters

Quarterly CMS updates can affect claim processing, payment status, and reporting requirements for outpatient hospital services. Understanding which code and modifier changes are discussed helps revenue cycle teams identify claims that may need review or adjustment.

Article Sections

1. Complexity adjustments in comprehensive APCs

   Summarizes changes to CMS outpatient payment logic for comprehensive APCs and the types of code pair updates discussed in the article.

2. Updates to devices

   Covers CMS review of device-related outpatient claims, including offset and pass-through topics, APC assignments, and retroactive effective dates.

3. Hyperbaric oxygen therapy

   Explains reporting updates related to hyperbaric oxygen therapy, including a deleted code, a replacement reporting code, and time-based billing considerations.

4. New and deleted codes

   Reviews newly implemented and deleted CPT Category III and HCPCS codes, along with their outpatient payment status assignments.

5. Modifier updates

   Summarizes modifier revisions discussed in the CMS update, including one deleted modifier and reiterated reporting guidance for another modifier.