Never Pay APGs Under APG Reimbursement

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.

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