OPPSPAYMENTPACKAGING--PACEMAKERPROCEDURES

C. If there are multiple comprehensive APCprocedures existing on the same claim from the different categories listed above, the comprehensive APCprocedures are packaged (SI = N) according to the hierarchy of services present; the procedure or service highest in the hierarchy is assigned the comprehensive APCfor the claim Additional processing conditions for each of the different categories is listed separately below

Outside of the ordinary APCreimbursement rate, there are only two ways that both procedures 33210 and 33208 reported on the same claim wilI qualify for additional reimbursement under OPPS? and that additional reimbursement would be paid on only the primary J1 code on the claim:

- Certain combinations of two or more HCPCSwith status J1 on the same claim will trigger a higher payment due to a ?complexity adjustment?? but that higher payment will be included in the amount paid on the primary code

- If a claim has an extraordinarily high amount of charges, the claim may become eligible for additional ?outlier?reimbursement ? but this claim did not meet outlier criteria

This case did not qualify for a complexity adjustment, nor were the total charges high enough to generate additional reimbursement under OPPSOutlier methodology

Com plexit y Adjust m ent - For certain combinations of J1 procedure reported on the same claim, OPPSprovides for additional payment on the primary code called a ?complexity adjustment.?CMSpublishes the list of code combinations that result in a complexity adjustment in Addendum Jof the OPPSFinal Rule.In the 2023 Addendum J, the combination of 33208 with 33210 does not qualify for a complexity adjustment.

Here?s an excerpt from Addendum Jindicating that the code pair 33208 with 33210 did not qualify for a complexity adjustment in 2023 (note there are several tabs in the workbook):