OPPSPAYMENTPACKAGING--PACEMAKERPROCEDURES

paid on the primary code, which payment has already taken into account the typical costs for accompanying procedures ? including a temporary pacemaker procedure We found a claim that illustrates Medicare?s OPPSpayment for the services described within the Medicare claims database, using the PARA Dat a Edit or CMS tab:

Here?s an excerpt from the Medicare document that explains status indicator J1 (Addendum D1 of the OPPSFinal Rule) ? it explains that ?all covered Part B services on the claim are packaged with the primary ?J1?service for the claim? ?:

Here?s an excerpt from Medicare?s Integrated OCE(IOCE) CMSSpecifications V24.0, effective 1/1/2023, which explains how Comprehensive APCpayment is processed:

5.5 Com prehensive APC Processing

Effective 1/1/2015 (v16 0), certain high cost procedure codes which have an SI=J1 are paid an all-inclusive rate to include all services submitted on the claim, except, for services excluded by statute All allowed, adjunctive services submitted on the claim are packaged into the ?comprehensive?APCpayment rate (i e , the status indicator is changed to N) Multiple comprehensive procedures, if present on the claim in specified combinations, may be assigned to a higher-paying comprehensive APCrepresenting a complexity adjustment. Services that are excluded from the all-inclusive payment retain their standard APCand SI for standard processing.