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Last Modified: 9/23/2019 Location: FL, PR, USVI Business: Part B, Part A

Redeterminations for HCPCS G0463 paid under OPPS

The Centers for Medicare & Medicaid Services (CMS) finalized a policy in the 2019 outpatient prospective payment system (OPPS) to reduce the payment rate for Healthcare Common Procedure Coding System (HCPCS) code G0463 when furnished in excepted off-campus provider-based departments of hospitals. This reduction is being implemented in a two-year transition with half of the total 60 percent payment reduction (30 percent reduction) being applied for calendar year (CY) 2019. For CY 2019, this means you will be paid approximately 70 percent of the OPPS rate for G0463. For CY 2020, you will be paid the site-specific physician fee schedule (PFS) rate for G0463.
Please note that redeterminations are not available for review of the payment rates or reductions in payment rates under OPPS. If redeterminations are received for this purpose, the request will be dismissed.
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