Never Pay APGs Under APG Reimbursement

Revised for for January 1, 2019 Updates:

Note: Information revised during the quarterly update period stated above is highlighted.
APG APG Desc APG Type Alternative
Payment
Available *
Date added
to
Never Pay 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 BEHAVIORAL HEALTH Per Diem No 12/1/2008 7/1/2010
313 Half Day Partial Hospitalization For Substance Abuse Per Diem No 12/1/2008 1/1/2019
314 Half Day Partial Hospitalization For Mental Illness Per Diem No 12/1/2008 1/1/2019
319 ACTIVITY THERAPY Significant Procedure No 12/1/2008  
320 BEHAVIORAL HEALTH – CASE MANAGEMENT AND TREATMENT PLAN DEVELOPMENT Significant Procedure No 12/1/2008 7/1/2010
371 LEVEL I 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  
459 VACCINE ADMINISTRATION Ancillary No 7/1/2017  
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.