Never Pay APGs Under APG Reimbursement

Revised for July 1, 2021 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 Diagnostic or Therapeutic Proc No 12/1/2008 7/1/2021
66 PULMONARY REHABILITATION Physical Therapy & Rehab No 12/1/2008  
94 CARDIAC REHABILITATION Physical Therapy & Rehab No 12/1/2008 1/1/2010
102 CONSULTATIVE TELEHEALTH ASSESSMENTS MEDICAL VISIT INDICATOR Incidental No 1/1/2020  
117 HOME INFUSION Diagnostic or Therapeutic Proc No 12/1/2008  
118 NUTRITION THERAPY Physical Therapy & Rehab No 12/1/2008 1/1/2010
157 REPRODUCTIVE PATHOLOGY TESTS Ancillary No 7/1/2021
190 ARTIFICIAL FERTILIZATION Diagnostic or Therapeutic Proc No 12/1/2008  
246 CLASS IV THERAPEUTIC RADIOPHARMACEUTICALS Drug Yes 1/1/2020  
311 FULL DAY PARTIAL HOSPITALIZATION FOR SUBSTANCE ABUSE Per Diem No 12/1/2008 1/1/2020
312 BEHAVIORAL AND SUBSTANCE ABUSE PARTIAL HOSPITALIZATION PROGRAM 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 Behavioral Health & Counseling No 12/1/2008  
320 BEHAVIORAL HEALTH – CASE MANAGEMENT AND TREATMENT PLAN DEVELOPMENT Behavioral Health & Counseling No 12/1/2008 7/1/2010
326 OPIOID TREATMENT PROGRAM SERVICES Significant Procedure No 1/1/2020 7/1/2021
371 LEVEL I ORTHODONTICS Dental 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  
466 CLASS XIV COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY Drug Yes – carve out 7/1/2021  
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  
2000 DIAGNOSTIC RADIOPHARMACEUTICAL Incidental No 1/1/2020  
2001 DIAGNOSTIC CONTRAST MEDIA Incidental No 1/1/2020  
2002 INCIDENTAL IMAGING SERVICES Incidental No 1/1/2020  
2003 INCIDENTAL PHYSICIAN REPORT OR TECHNICAL SERVICES Incidental No 1/1/2020  
2004 INCIDENTAL MINOR DIAGNOSTIC TESTS Incidental No 1/1/2020  
2005 INCIDENTAL MEDICAL VISIT SERVICES Incidental No 1/1/2020  
2006 INCIDENTAL IMPLANTABLE OR OTHER RELATED DEVICES Incidental No 1/1/2020  
2007 INCIDENTAL BEHAVIORAL HEALTH SERVICES Incidental No 1/1/2020  

* 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.