Never Pay APGs Under APG Reimbursement

Revised for for January 1, 2016 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  
385 Level I Molecular Pathology And Genetic Tests Ancillary Yes/No - carve out** 1/1/2016  
386 Level Ii Molecular Pathology And Genetic Tests Ancillary Yes/No - carve out** 1/1/2016  
387 Level Iii Molecular Pathology And Genetic Tests Ancillary Yes/No - carve out** 1/1/2016  
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.

∗∗ Refer to "Never Pay Procedures" list to verify whether a procedure of APG 385 has alternative payment available or not.