Never Pay APGs Under APG Reimbursement
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Revised for July 1, 2012 Updates:
Information revised since the last update is highlighted.
| APG | APG Desc | APG Type | Alternative Payment Available ∗ |
Date Added to List |
Date Removed from Never Pay List |
|---|---|---|---|---|---|
| 65 | Respiratory Therapy | Significant Procedure | No | 12/1/2008 | |
| 66 | Pulmonary Rehabilitation | Significant Procedure | No | 12/1/2008 | |
| 94 | Cardiac Rehabilitation | Significant Procedure | No | 12/1/2008 | 1/1/2010 |
| 117 | Home Infusion | Significant Procedure | No | 12/1/2008 | |
| 118 | Nutrition Therapy | Significant Procedure | No | 12/1/2008 | 1/1/2010 |
| 190 | Artificial Fertilization | Significant Procedure | No | 12/1/2008 | |
| 311 | Full Day Partial Hospitalization For Substance Abuse | Per Diem | No | 12/1/2008 | |
| 312 | Full Day Partial Hospitalization For Mental Illness | Per Diem | No | 12/1/2008 | 7/1/2010 |
| 313 | Half Day Partial Hospitalization For Substance Abuse | Per Diem | No | 12/1/2008 | |
| 314 | Half Day Partial Hospitalization For Mental Illness | Per Diem | No | 12/1/2008 | |
| 319 | Activity Therapy | Significant Procedure | No | 12/1/2008 | |
| 320 | Case Management & Treatment Plan Development - Mental Health Or Substance Abuse |
Significant Procedure | No | 12/1/2008 | 7/1/2010 |
| 371 | Orthodontics | Significant Procedure | Yes - carve out | 12/1/2008 | |
| 427 | Biofeedback And Other Training | Ancillary | No | 12/1/2008 | 7/1/2010 |
| 430 | Class I Chemotherapy Drugs | Drug | Yes - carve out | 12/1/2008 | |
| 431 | Class II Chemotherapy Drugs | Drug | Yes - carve out | 12/1/2008 | |
| 432 | Class III Chemotherapy Drugs | Drug | Yes - carve out | 12/1/2008 | |
| 433 | Class IV Chemotherapy Drugs | Drug | Yes - carve out | 12/1/2008 | |
| 434 | Class V Chemotherapy Drugs | Drug | Yes - carve out | 12/1/2008 | |
| 441 | Class VI Chemotherapy Drugs | Drug | Yes - carve out | 1/1/2010 | |
| 442 | Class VII Combined Chemotherapy & Pharmacotherapy | Drug | No | 1/1/2010 | 1/1/2011 |
| 443 | CLASS VII CHEMOTHERAPY DRUGS | Drug | Yes - carve out | 1/1/2011 | |
| 450 | Observation | Ancillary | No | 12/1/2008 | 1/1/2011 |
| 452 | Diabetes Supplies | DME | Yes - carve out | 12/1/2008 | |
| 453 | Motorized Wheelchair | DME | Yes - carve out | 12/1/2008 | |
| 454 | Tpn Formulae | DME | Yes - carve out | 12/1/2008 | |
| 456 | Motorized Wheelchair Accessories | DME | Yes - carve out | 12/1/2008 | |
| 465 | CLASS XIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY | Drug | Yes - carve out | 7/1/2011 | |
| 492 | Direct Admission For Observation Indicator | Incidental | No | 12/1/2008 | 1/1/2011 |
| 495 | MINOR CHEMOTHERAPY DRUGS | Drug | Yes - carve out | 7/1/2012 | |
| 500 | Direct Admission For Observation - Obstetrical | Medical Visit | No | 12/1/2008 | 1/1/2011 |
| 501 | Direct Admission For Observation - Other Diagnoses | Medical Visit | No | 12/1/2008 | 1/1/2011 |
| 999 | Unassigned | Unassigned | No | 12/1/2008 |
∗ APGs listed as carve outs should not be billed using APGs. Indication as a carve out does not guarantee alternative payment.
