Reimbursement Update: Update Your Systems To Handle OPPS, ASC Changes That Take Effect July 1, 2017

Why This Topic Matters

Facilities that bill OPPS and ASC claims need to update charge capture, payment logic, and coding workflows when CMS changes become effective mid-year. This update helps readers identify which broad categories of services and codes were affected so they can review the full guidance and associated CMS MLN Matters articles.

Article Sections

1. Mid-Year Payment Changes for HOPDs and ASCs

   Introduces the July 1, 2017 update and the facility settings affected. It frames the article as a summary of reimbursement changes and points readers to related CMS guidance.

2. Separately Payable HCPCS Codes

   Covers new HCPCS procedure codes that received separately payable status in the outpatient and ambulatory surgery environments. The section identifies the categories of procedures affected.

3. Drug Pass-Through Status

   Summarizes drugs that received pass-through status for the update period. It explains the reimbursement context at a high level without going into selection details.

4. New HCPCS Drug Codes

   Reviews newly added HCPCS codes for drugs and notes their general relevance to outpatient and surgery center billing. It distinguishes the codes discussed in the article without providing coding guidance.

5. Flu Vaccine Payment Timing

   Notes the annual timing change for flu vaccine payment in the affected settings. This section ties the update to the upcoming influenza season.

6. Category III CPT Codes Added Under OPPS

   Describes the addition of Category III CPT codes under OPPS and groups them by broad clinical area. It also references the general status of Category III codes within CPT.