Health Information Management

Tip: CMS restructures APCs for nine clinical families

APCs Insider, January 22, 2016

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CMS followed through with its proposal to restructure APCs for nine clinical families in the 2016 OPPS final rule, with a few tweaks for specific services and procedures based on commenter suggestions.
CMS based the new groupings on the following:
  • Greater simplicity and improved understandability of the OPPS APC structure
  • Improved clinical homogeneity
  • Improved resource homogeneity
  • Reduced resource overlap in long-standing APCs
Following restructuring of ophthalmology and gynecology APCs in the 2015 OPPS final rule, CMS finalized restructuring in the following clinical families in the 2016 final rule:
  • Airway endoscopy procedures
  • Cardiovascular procedures and services
  • Diagnostic tests and related services
  • Eye surgery and other eye-related procedures
  • Gastrointestinal procedures
  • Gynecologic procedures and services
  • Incision and drainage and excision/biopsy procedures
  • Imaging-related procedures
  • Orthopedic procedures 
For full details of changes to APCs relevant for your facility, see section III.D of the final rule. 


This tip is adapted from “CMS backs off some burdensome proposals but imposes negative payment update in latest rule” in the January issue of Briefings on APCs.

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