Corporate

April 22, 2015

OPPS Addenda

Each calendar year, the statutory requirements and payment rates for services paid under the Outpatient Prospective Payment System (OPPS) are updated per the annual Hospital OPPS Final Rule and published on the Hospital Outpatient Regulations and Notices page on the CMS website.

Several addenda that describe OPPS APC payment assignments are also published with the Final Rule and can be found in the Related Links section of each Final Rule page. The following table lists each addendum and its description.

Addendum Description
A A list of Ambulatory Payment Classification (APC) groups, their description, status indicator and payment rate. Addendum A is also updated quarterly and published on the CMS Hospital Outpatient PPS Addendum A and B Updates page.
B A list of HCPCS codes, their short descriptor, status indicator, APC assignment and payment rate. Addendum B is also updated quarterly and published on the CMS Hospital Outpatient PPS Addendum A and B Updates page.
C A list of HCPCS codes assigned to each APC, the status indicator and payment rate.
D1 A list of status indicators, their description and OPPS payment status.
D2 A list of comment indicators and their description.
E A list of HCPCS codes that are only paid as inpatient procedures (status indicator C).
J A list of HCPCS codes that are assigned to a comprehensive APC payment (status indicator J1), their APC assignment and rank used for primary assignment when more than one of these codes is reported on a claim.
L A list of Medicare provider numbers and their OPPS Out Migration Adjustment.
M A list of HCPCS codes assigned to a composite APC payment (status indicator Q3), their short descriptor, single code APC assignment and composite APC assignment.
N A list of bypass codes for creating "pseudo" single procedure claims for calculating geometric mean costs.

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