General Question for the Week of May 25, 2020

Question:

Do the new Appropriate Use Criteria (AUC) modifiers and G codes have to be added to hospital claims as well as interpreting physician claims?

Answer:

Yes, this applies to outpatient hospitals and ASCs, as well as imaging centers, and physicians. Basically, the rule is applicable to anyone paid through the Hospital Outpatient Prospective Payment System (OPPS), Medicare Physician Fee Schedule (MPFS), or the Ambulatory Surgical Center (ASC) fee schedules. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Appropriate-Use-Criteria-Program/index.html

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.

General Question for the Week of May 25, 2020

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