REIMBURSEMENT
INFORMATION
This Reimbursement Guide was developed to assist you with the billing of medical procedures. The coding information is for informational purposes only; it is subject to change and should not be construed as legal advice. Providers should exercise clinical judgement when selecting codes and submitting claims to accurately reflect the services and products rendered.
Coding And Reimbursement Information
To view coding & reimbursements information, simply click on the appropriate product or procedure category below.
Mammography
Hysterosalpingography & Sonohysterography
Endomyocardial Biopsy
Healthcare Coding Systems
Reimbursement for any product or procedure can vary depending upon the setting in which it is used. Because the reimbursements listed here are based on Medicare national averages, the actual payment or reimbursement rates will vary for each provider or institution.
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CPT® |
Current Procedural Terminology used by healthcare providers, payers and facilities to code procedures and services in all settings of care and reimbursement that a practitioner will receive for services provided |
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HCPCS |
Healthcare Common Procedure Coding System that is broken into Level I and II. Level I utilizes CPT coding, and Level II identifies products, supplies, and services not included in CPT |
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APC |
Ambulatory Payment Classification that is the unit of payment in most cases under the Hospital Outpatient Prospective Payment System (OPPS). The Centers for Medicare & Medicaid Services (CMS) assigns HCPCS codes to APCs based on similar clinical characteristics and similar costs |
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ASC |
Ambulatory Surgery Centers payment group utilizes HCPCS codes assigned to each of the procedure codes and determines the amount that Medicare pays for facility services furnished in connection with a covered procedure |
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ICD-10-PCS |
Procedural codes (PCS) from the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) used on hospitalized inpatients. ICD-10-CM comes from the same revision but is specific to clinical modifiers for diagnosing (CM) |
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MS-DRG |
The Medicare Severity Diagnosis Related Groups is a classification system for an inpatient stay based on principal diagnosis, additional diagnoses and procedures |
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C-Code |
Unique temporary pricing codes established by the Centers for Medicare and Medicaid Services (CMS) and only valid for Medicare on claims for hospital outpatient department services and procedures |
Reimbursement References:
1 2020 Medicare Physician Services Fee Schedule (Physician) (www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx)
2 2020 Medicare Outpatient Hospital Fee Schedule (APC) (www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1717-cn)
3 2020 Medicare Ambulatory Surgery Center Fee Schedule (ASC) (www.cms.gov/apps/ama/license.asp?file=/files/zip/july-2020-asc-approved-hcpcs-code-and-payment-rates.zip)
4 Procedural codes (PCS) from the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) used on hospitalized inpatients. ICD-10-CM comes from the same revision but is specific to clinical modifiers for diagnosing (CM) (www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-PCS)
5 The Medicare Severity Diagnosis Related Groups is a classification system for an inpatient stay based on principal diagnosis, additional diagnoses and procedures (www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software)
6 Unique temporary pricing codes established by the Centers for Medicare and Medicaid Services (CMS) and only valid for Medicare on claims for hospital outpatient department services and procedures (https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/Downloads/2018-11-30-HCPCS-Level2-Coding-Procedure.pdf)
Disclaimer: Argon Medical Devices, Inc. does not warrant or guarantee that the use of this information will result in coverage or reimbursement for our products at any particular level. Hospitals and physicians are solely responsible for their compliance with Medicare and other payor rules and requirements, and for the information submitted with all claims and appeals. Before any claims or appeals are submitted, healthcare providers should review official payor instructions and requirements, and confirm the accuracy of their coding or billing practices with these payors. Hospitals and physicians should use independent judgment when selecting codes that most appropriately describe the services or supplies provided to a patient. The content is not intended to instruct hospitals and/or physicians on how to use medical devices or bill for healthcare procedures.
Argon Medical makes no representation or warranty regarding this information or its completeness or accuracy and will bear no responsibility for the results or consequences of the use of this information.
CPT® is a registered trademark of American Medical Association (AMA). CPT Coding and descriptors are copyrighted by AMA.
Last Updated: August 2020
