Workgroup Formed to Petition CMS for Appropriate APC Payment Assignment

The AMA created a new category of CPT codes in the vascular space, bundling previously reported component codes. The proposed rules reported payment inequity in the hospital outpatient department for procedures using multiple devices in a single surgical session.

The JD LYMON Solution: We formed and led a workgroup of device manufacturers who had a vested interest in this therapeutic area. The workgroup prepared economic cost models and a cohesive argument for appropriate CPT to APC assignment and presented their proposal to CMS.

Results: CMS made several adjustments to CPT code assignments within the APC payment structure in the final rule. This avoided severe payment discrimination in a predominate setting of care.

Additional Case Studies