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