An in-depth review of July updates to the OPPS and I/OCE

Why This Topic Matters

Quarterly OPPS and I/OCE updates can affect outpatient claim processing, payment grouping, and edit outcomes. Understanding the scope of these changes helps facilities identify whether the release may affect charge capture, billing workflow, and Medicare Part B claim handling.

Article Sections

1. Key July OPPS updates

   Overview of the major categories of changes included in the July 2019 outpatient payment update. Covers new and revised HCPCS activity, APC-related updates, and status indicator changes.

2. New Temporary C-code, effective July 1, 2019

   Introduces a newly created temporary HCPCS code and notes its placement within the July outpatient update.

3. New CPT Category III Codes, effective July 1, 2019

   Summarizes the addition of new Category III codes implemented in the July 2019 release and their inclusion in outpatient processing resources.

4. CPT Proprietary Laboratory Analyses (PLA) Coding Changes, effective July 1, 2019

   Describes PLA code deletions and additions effective with the July 2019 update and their appearance in outpatient code-edit materials.

5. Myocardial imaging by magnetocardiography (MCG)

   Reviews update activity related to MCG-related CPT codes, including outpatient status and payment-category revisions.

6. Drugs, biologicals and radiopharmaceuticals

   Covers July 2019 changes affecting drug and biological reporting, including new HCPCS additions, pricing updates, skin substitute grouping, and vaccine-related revisions.

7. July 2019 I/OCE update

   Summarizes the related I/OCE transmittal and the types of processing specifications updated for institutional Part B claims. Also notes the addition of a new edit and references the associated attachment materials.