Ambulatory Care Payment Reform - Ambulatory Patient Groups (APGs)
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Table of Contents
- Important APG Updates UPDATED July 2011
- APG Provider Manual UPDATED
- Reimbursement Methodology UPDATED
- APG Consolidation/Bundling UPDATED
- Ancillary Policy UPDATED October 2011
- Hospital APG Base Rates, Capital Add-Ons, and Existing Payment for Blend
- Free-Standing Diagnostic and Treatment Center Base Rates, Capital Add-ons, and Existing Payment for
Blend and Free-Standing Ambulatory Surgery CentersUPDATED - APG Rates for Out of State Providers
- FQHC APG Medicaid Reimbursement Option
- APG Regulations
- Implementation Schedule UPDATED May 2010
- 3M APG CrosswalkUPDATED
- Contact Information UPDATED
Important APG Updates (July, 2011)
- July 2011
- Epogen & 3107 Subsumed by APGs (PDF, 10KB, 1pg.)
- Use of Visit and Episode Rate Codes in Free-Standing Diagnostic and Treatment Centers (PDF, 12KB, 2pg.)
- May/June 2011
- NCCI Edits Applied to APG Claims (PDF, 15KB, 1pg.)
- U6 Modifier Policy (PDF, 45KB, 3pg.)
- Family Planning
- Billing Guidance(PDF, 12KB, 1pg.)
- Family Planning Procedure and Diagnosis Codes(XLS, 38KB
- 3M EAPG Mainframe Software Known Product Issue - alert regarding procedure based weights grouping to APG 490 Incidental to Medical, Significant Procedure; Therapy Visit Issue Alert: Proc Based grouping to 490 not paying; (PDF, 10KB, 1pg.)
- HIV/AIDS Counseling and Testing Service Rate Codes will be Subsumed by the APG Payment System on July 1, 2011 (delayed from April 1, 2011): (PDF, 102KB, 1pg.)
- Dental Anesthesia (PDF, 12KB, 1pg.)
- Dental POS Billing
- 3M EAPG Mainframe Software Known Product Issue - alert regarding visit rate codes being treated as episode rate codes (PDF, 10KB, 1pg.)
- February 2011
- Important information regarding January 2011 billing changes for dialysis clinic providers (PDF, 63KB, 1pg.)
- HIV/AIDS Counseling and Testing Service Rate Codes will be Subsumed by the APG Payment System on July 1, 2011 (delayed from April 1, 2011): (PDF, 102KB, 3pg.)
- Implementation for the New Ancillary Billing Policy for Free-Standing Diagnostic and Treatment Centers has now been delayed until July 1, 2011. Free-Standing Diagnostic and Treatment Centers now have until May 31, 2011 to opt into the contracting option. Detailed information is available at: (PDF, 45KB, 3pg.)
- January 2011
- Reimbursement changes for Vagus Nerve Stimulation (VNS) Therapy services (PDF, 13KB, 1pg.)
- January 2011 APG Updates and Changes (PDF, 93KB, 5pg.)
- January 1, 2011 APG Changes Presented to Hospitals on December 17, 2010: (PDF, 177KB, 18pg.)
- December 2010
- New APG Hospital Base Rates loaded in December 2010 to provider rate files. - Hospital base rate updates (PDF, 9KB, 1pg.)
- Hospital APG base rates for all established periods (PDF, 55KB, 1pg.)
- June 2010
- The New York State Department of Health (SDOH) is pleased to announce that the federal Centers for Medicare and Medicaid Services (CMS) approved the State Plan Amendment authorizing the Ambulatory Patient Group Payment (APG) Medicaid payment methodology for freestanding Diagnostic and Treatment Centers and Ambulatory Surgery Centers on June 14, 2010. The effective date is September 1, 2009. Click here for detailed billing guidance for DTCs and ambulatory surgery centers (PDF, 138KB, 3pg.)
- June 2010 APG Provider Manual (PDF, 1.52MB, 66pg.)
APG Training Materials
Training Presentation
- Power Point Presentation on NY Medicaid's Prenatal Care Standards ( Feb 3 and 4, 2009) (PDF, 590KB, 89pg.)
- Changes in APG Reimbursement (PDF, 224KB, 27pg.) <( January 2010)
- APG Implementation - Ambulatory Care Payment Reform-Hospitals (PDF, 786KB, 138pg.)
- PowerPoint Presentation- Ambulatory Patient Groups (APGs) - DTCs and Ancillary Lab/Radiology Services (9/3/2009) (PDF, 403KB, 63pg.)
- PowerPoint Presentation- Ambulatory Patient Groups (APGs) and Family Planning (PDF, 512KB, 92pg.)
- PowerPoint Presentation- Ambulatory Patient Groups (APGs) and Prenatal Care (PDF, 481KB, 94pg.)
- PowerPoint Presentation- Ambulatory Patient Groups (APGs) and School Based Health Centers (PDF, 504KB, 87pg.)
- PowerPoint Presentation- Ambulatory Patient Groups (APGs) and Laboratory Services (PDF, 368KB, 53pg.)
Webinar Information and Materials
September 24, 2010 - Informational Webinar for Laboratory Providers on the Ambulatory Patient Group (APG) Payment Methodology
The New York State Department of Health (SDOH) held an informational webinar regarding reimbursement of ancillary laboratory services under the Ambulatory Patient Group (APG) methodology on Thursday, September 23, 2010 from 10 am to 12:30 pm.
September 23, 2010 Webinar
The powerpoint presentation that was used during the September 23, 2010 webinar is below:
- September 23, 2010 Presentation (PDF, 208KB, 43pg.)
The recording for the September 23, 2010 webinar can be accessed using the following link:
Questions posed during the September 23rd webinar have been responded to and are posted below:
- September 23, 2010 webinar Q&As (PDF, 81KB, 10pg.)
August 18, 2010 Webinar
The powerpoint presentation for the August 18, 2010 webinar is below:
- August 18, 2010 Presentation (PDF, 483KB, 84pg.)
The recording for the August 18, 2010 webinar can be accessed using the following link:
- August 18, 2010 webinar recording (WMV)
- Q&As (PDF, 80KB, 10pg.)
June 21 Webinar Q&As
- Q&As (PDF, 87KB, 16pg.)
APG Reimbursement Methodology
APG Consolidation/Bundling
Ancillary Policy
- Procedures Subject to the Ancillary Policy:
- Hospitals - see APG Provider Manual (section 4.4) (PDF, 1.52MB, 6pg.)
- Free-Standing (PDF, 45KB, 3pg.)
- Free-Standing Clinics Contracting for Ancillary Services - DTC Contracting for ancillaries (PDF, 55KB, 1pg.)
Hospital APG Base Rates, Capital Add-Ons, and Existing Payment for Blend
- Hospital APG Base Rates (PDF, 55KB, 1pg.)
- New York State Provider existing payment for blend and capital add-on rates
- ALL New York State and out-of-state hospital rates (base rates, capital add-ons, and existing payment for blend) by NPI, entity ID, provider ID, and locator code (UPDATES ONLY - Providers are only included in a file if their rates were adjusted during the time period listed):
- Dec. 1, 2008 - June 30, 2009 (XLS, 1.77MB)
- July 1, 2009 - Nov. 30, 2009 (XLS, 4.86MB)
- Dec. 1, 2009 - Dec. 31, 2009 (XLS, 1.51MB)
- Jan 1, 2010 - June 30, 2010 (XLS, 4.85MB)
- July 1, 2010 - Dec. 31, 2010 (XLS, 5.94MB)
- Jan. 1, 2011 - May 2, 2011 (XLS, 2.03M)
Free-Standing Diagnostic and Treatment Center Base Rates, Capital Add-ons, and Existing Payment for Blend and Free-Standing Ambulatory Surgery Centers - (UPDATED )
- Base rate table (PDF, 89KB, 1pg.)
- Provider capital add-on & blend (PDF, 1.14MB, 11pg.)
- Master rate files by NPI, entity ID, provider ID, and locator code (UPDATES ONLY - Providers are only included in a file if their rates were adjusted during the time period listed):
- Sept. 1, 2009 - Nov. 30, 2009 (XLS, 2.26MB)
- Dec. 1, 2009 - Dec. 31, 2009 (XLS, 1.52MB)
- Jan. 1, 2010 - Dec. 31, 2010 (XLS, 1.57MB)
- Jan. 1, 2011- May 2, 2011 (XLS, 405KB)
APG Rates for Out of State Providers
- Average Regional APG Rates for Out of State Providers - July 2009 (PDF, 55KB, 1pg.)
FQHC APG Medicaid Reimbursement Option
FQHCs may participate in the APG reimbursement methodology as an "alternative rate setting methodology" as authorized by Public Health Law Section 2807(8)(f). Importantly, FQHCs con not be harmed by opting into APG reimbursement methodology because they are entitled to receive supplemental payments reflecting the difference between total APG reimbursement and the aggregate amount they would have received under the federal prospective payment system (PPS), if the latter is higher. To opt into the APG reimbursement methodology for the upcoming calendar year, FQHCs must declare their intention by downloading and signing the authorization below. The authorization should be returned to the Department of Health as indicated before November 1st prior to the calendar year the FQHC wishes to participate in APGs.
- FQHC APG Medicaid Reimbursement Option Declaration Form (7-19-11) (PDF, 440KB, 2pg.)
APG Regulations
- The original regulations were filed with the Department of State on 11/18/08 and became final on 12/03/08
- APG Regulations (PDF, 280KB, 46pg.)
- The APG regulations were amended with the Department of State effective December 4, 2009. The amendments were submitted as emergency regulations and are currently in effect unless altered by the more recent amendments.
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- APG Amendments 1 (PDF, 75KB, 25pg.)
- The regulations were further amended with the Department of State effective January 29, 2010. The amendments were
submitted as emergency regulations and are currently in effect.
- APG Amendments 2 (PDF, 128KB, 47pg.)
APG Implementation Schedule
3M APG Crosswalk
Contact Information
- Contact Information (PDF, 29KB, 1pg.)
