2014 OPPS Final Rule Outcome for Collapse of E/M Levels

For 2014 CMS has finalized the collapse of the clinic visit codes. They have opted to not include Type A or B ED visits at this time. The national reimbursement rate for G0463 under APC 0634 is $92.53. CMS will continue to explore the ED visits and address in future rule making. For now, hospital systems need to be set up to accommodate the new G code for new and established patient clinic visit codes for billing to Medicare.

TABLE 42. – CY 2013 CLINIC AND EMERGENCY DEPARTMENT VISIT HCPCS CODES AND APC ASSIGNMENTS COMPARED TO CY 2014 CLINIC AND EMERGENCY DEPARTMENT VISIT HCPCS CODES AND APC ASSIGNMENTS

Visit Type

CY 2013

CY 2014

HCPCS Code

APC

HCPCS Code

APC

CLINIC VISIT

99201

0604

G0463

0634

99202

0605

99203

0606

99204

0607

99205

0608

99211

0604

99212

0605

99213

0605

99214

0606

99215

0607

TYPE A

ED VISIT

99281

0609

99281

0609

99282

0613

99282

0613

99283

0614

99283

0614

99284

0615

99284

0615

99285

0616

99285

0616

TYPE B

ED VISIT

G0380

0626

G0380

0626

G0381

0627

G0381

0627

G0382

0628

G0382

0628

G0383

0629

G0383

0629

G0384

0630

G0384

0630

 


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