Ashley attended an in-service education program about the outpatient prospective payment system (OPPS) where she learned that certain Medicare Part B services are paid according to ambulatory payment classifications (APCs), which group services according to similar clinical characteristics and in terms of resources required. A payment rate is established for each APC and, depending on services provided, hospitals may be paid for more than one APC for a patient encounter.

As part of the in-service, Ashley is provided with the following information and required to answer each question by applying the formula to calculate APC payments.

1. What is the APC payment for HCPCS code 66984? Round the answer to two decimal points. $ ______

2. What is the APC payment for HCPCS code 71046? Round the answer to two decimal points. $ ______

3. What is the APC payment for HCPCS code 78740? Round the answer to two decimal points. $ ______

4. What is the total APC payment for HCPCS codes 66984, 71020, and 78740? Round the answer to two decimal points. $ ______

 

Outpatient Prospective Payment System (OPPS) Formula (APC Weight x Conversion Factor x Wage Index) + Add-On Payments = Payment NOTE: When a patient undergoes multiple procedures and services on the same day, multiple APCS are generated and payments are added together. APC software automatically discounts multiple APC payments when appropriate (e.g., bilateral procedure). Conversion Factor = $68.75 Wage Index = 0.9445 HCPCS Code Description Cataract procedure with intraocular lens implant Chest x-ray, 2 views Ureteral reflux study APC APC Weight 66984 246 24.56 71046 260 1.56 78740 292 3.94