2015 APG Updates/Policy Changes
January 2015
- Error in the January 1, 2015 APG grouper/pricer
An error in the January 2015 APG grouper/pricer release has resulted in underpayment of some APG claims. The APG relative weights for APGs 486, 487, 488, 489, and 882, that were effective beginning January 1, 2015, were inadvertently omitted from the 3M grouper/pricer software that was used in the eMedNY payment system. The Department of Health has, however, implemented a revised 3M APG grouper/pricer on February 5, 2015 that corrects this omission.
Although this error was corrected for claims paid beginning February 5, 2015, some Medicaid claims may have been paid with a 0.0000 weight for these APGs. The specific claims that providers will need to review will need the following conditions to exist for the claim to not have paid properly:
- Claims with service dates January 1, 2015 through February 4, 2015 and submitted for payment PRIOR TO February 5, 2015.
- Claims with HCPCS codes that map to APGs 486, 487, 488, 489, or 882 and the weight paid on the claim for these APGs is 0.0000.
If a provider has Medicaid claims that meet the criteria above, in order to receive payment for the specific APGs listed above where the line on the APG claim paid $0.00, providers must resubmit the claims.
The impacted APGs and HCPCS codes assignment are listed below. Billing questions may be directed to CSC at 1-800-343-9000.
Impacted APG/HCPCS code assignment information:
EAPG 0486 BASIC BLOOD TYPING
HCPCS CODES
86900 Blood typing serologic abo
86901 Blood typing serologic rh(d)
86902 Blood type antigen donor ea
86904 Blood typing patient serum
86905 Blood typing rbc antigens
86906 Bld typing serologic rh phnt
86910 Blood typing paternity test
86911 Blood typing antigen system
86920 Compatibility test spin
86921 Compatibility test incubate
86945 Blood product/irradiation
86978 Rbc pretreatment serum
EAPG 0487 MINOR CARDIAC MONITORING
HCPCS CODES
0311T Cal & alys cntrl artl press
0389T Prog eval inper leadls pm
0391T Intergt eval inper leadls pm
93225 Ecg monit/reprt up to 48 hrs
93226 Ecg monit/reprt up to 48 hrs
93270 Remote 30 day ecg rev/report
93786 Ambulatory bp recording
93788 Ambulatory bp analysis
G0166 Extrnl counterpulse, per tx
EAPG 0488 MINOR DEVICE EVALUATION & ELECTRONIC ANALYSIS
HCPCS CODES
0224T Acoustic ecg 1+ analysis
0225T Acoustic ecg analy & reprog
0296T Ext ecg recording
0297T Ext ecg scan w/report
0305T Icar ischm mntrng prgrm eval
0306T Icar ischm mntr interr eval
0317T Elec alys vagus nrv pls gen
93279 Pm device progr eval sngl
93280 Pm device progr eval dual
93281 Pm device progr eval multi
93282 Prgrmg eval implantable dfb
93283 Prgrmg eval implantable dfb
93284 Prgrmg eval implantable dfb
93285 Ilr device eval progr
93288 Pm device eval in person
93289 Interrog device eval heart
93291 Ilr device interrogate
93292 Wcd device interrogate
93293 Pm phone r-strip device eval
93296 Pm/icd remote tech serv
93299 Icm/ilr remote tech serv
95970 Analyze neurostim no prog
95981 Io anal gast n-stim subsq
95982 Io ga n-stim subsq w/reprog
EAPG 0489 LEVEL II OTHER MISCELLANEOUS ANCILLARY PROCEDURES
HCPCS CODES
0108T Cool quant sensory test
15860 Test for blood flow in graft
19281 Perq device breast 1st imag
19282 Perq device breast ea imag
19283 Perq dev breast 1st strtctc
19284 Perq dev breast add strtctc
19285 Perq dev breast 1st us imag
19286 Perq dev breast add us imag
19287 Perq dev breast 1st mr guide
19288 Perq dev breast add mr guide
20665 Removal of fixation device
30200 Injection treatment of nose
30210 Nasal sinus therapy
30300 Remove nasal foreign body
30801 Ablate inf turbinate superf
30901 Control of nosebleed
30903 Control of nosebleed
31505 Diagnostic laryngoscopy
32552 Remove lung catheter
36593 Declot vascular device
36597 Reposition venous catheter
36598 Inj w/fluor eval cv device
40804 Removal foreign body mouth
42809 Remove pharynx foreign body
43761 Reposition gastrostomy tube
46604 Anoscopy and dilation
46754 Removal of suture from anus
49429 Removal of shunt
50389 Remove renal tube w/fluoro
51100 Drain bladder by needle
51101 Drain bladder by trocar/cath
51701 Insert bladder catheter
51702 Insert temp bladder cath
51703 Insert bladder cath complex
51736 Urine flow measurement
51741 Electro-uroflowmetry first
51792 Urinary reflex study
51798 Us urine capacity measure
54235 Penile injection
54240 Penis study
54250 Penis study
64550 Apply neurostimulator
65205 Remove foreign body from eye
65220 Remove foreign body from eye
69200 Clear outer ear canal
69210 Remove impacted ear wax uni
90867 Tcranial magn stim tx plan
90868 Tcranial magn stim tx deli
90869 Tcran magn stim redetemine
91120 Rectal sensation test
91122 Anal pressure record
92132 Cmptr ophth dx img ant segmt
92133 Cmptr ophth img optic nerve
92134 Cptr ophth dx img post segmt
92136 Ophthalmic biometry
92140 Glaucoma provocative tests
92250 Eye exam with photos
92260 Ophthalmoscopy/dynamometry
92285 Eye photography
92313 Contact lens fitting
92315 Rx cntact lens aphakia 1 eye
92316 Rx cntact lens aphakia 2 eye
92325 Modification of contact lens
92326 Replacement of contact lens
92358 Aphakia prosth service temp
92541 Spontaneous nystagmus test
92542 Positional nystagmus test
92570 Acoustic immitance testing
92572 Staggered spondaic word test
92575 Sensorineural acuity test
92577 Stenger test speech
92582 Conditioning play audiometry
92583 Select picture audiometry
92601 Cochlear implt f/up exam <7
92602 Reprogram cochlear implt 7/>
92603 Cochlear implt f/up exam 7/>
92604 Reprogram cochlear implt 7/>
92620 Auditory function 60 min
92625 Tinnitus assessment
92700 Ent procedure/service
93561 Cardiac output measurement
93562 Card output measure subsq
93740 Temperature gradient studies
95803 Actigraphy testing
95874 Guide nerv destr needle emg
95921 Autonomic nrv parasym inervj
95922 Autonomic nrv adrenrg inervj
95923 Autonomic nrv syst funj test
95933 Blink reflex test
95990 Spin/brain pump refil & main
95991 Spin/brain pump refil & main
96003 Dynamic fine wire emg
96521 Refill/maint portable pump
96522 Refill/maint pump/resvr syst
96523 Irrig drug delivery device
97597 Rmvl devital tis 20 cm/<
97598 Rmvl devital tis addl 20cm/<
G0268 Removal of impacted wax md
G0294 Non-cov proc, clinical trial
G0398 Home sleep test/type 2 porta
G0399 Home sleep test/type 3 porta
G0400 Home sleep test/type 4 porta
S2083 Adjustment gastric band
EAPG 882 GENETIC COUNSELING
PRINCIPAL DIAGNOSIS
V2633 Genetic counseling
