A novel technology in the GERD space was launched with an unlisted CPT code, which was automatically placed in the lowest paying hospital outpatient APC for that space. The unlisted code was excluded from payment by Medicare in the Ambulatory Surgery Center (ASC).

The JD LYMON Solution: We prepared a New Tech APC application and met with the Hospital Outpatient Group at CMS to review the technology.

Results: A C-code was granted and the technology was reassigned to a higher paying APC, resulting in an increase of more than $6,000 in the hospital outpatient setting and inclusion in the ASC fee schedule.