Implementation of APG payment Methodology delayed for free-standing diagnostic and treatment centers and ambulatory surgery centers

While scheduled for March 1, 2009, implementation of APGs in Diagnostic and Treatment Centers (D&TCs) including free-standing ambulatory surgery centers cannot begin until federal approval is received. The Department has responded to CMS’ request for additional information on the State Plan Amendment authorizing federal financial participation for APG payments. Discussions with CMS are ongoing and approval is anticipated soon.

DT&C providers should continue to submit claims for outpatient services to eMedNY using existing rate codes (not APG rate codes) until further notice. Claims should be fully coded with CPT/HCPCS codes and ICD-9 diagnosis codes in anticipation of reprocessing of these claims by eMedNY under the APG payment methodology back to March 1, 2009. However, D&TCs and ambulatory surgery centers should not include codes for ancillary services (lab and radiology services) currently being billed directly to Medicaid by ancillary service providers, and ancillary service providers should continue to directly bill Medicaid for these services until the new APG payment methodology is implemented.