RJ Health - Ambulatory Payment Classification (APC) - Explained

This segment is from RJ Health's On-Demand Webinar:

Shedding Light on Medically Covered Specialty Drug Pricing Methods

Presented by:
Christopher Webb, CPhT
Director, Product Development
&
Jason Young, PharmD
SVP, Clinical Data Operations

For more information contact: info@reimbursementcodes.com

For more webinars: www.mmitnetwork.com/rj-health-resources/

Our fourth level of pricing is APC rates - Ambulatory Payment Classification. These are utilized in outpatient hospitals. Again, these are published by CMS on a quarterly basis, in the majority of the cases they are based off of ASP pricing data. Right now, we see a 6 percent mark-up, but historically they are between 4 and 6 percent. This is code level only, again, based off the description of the code and billable unit. And there is a caveat to APC pricing, there are particular codes and products that do not have a separate rate, these are ones that are bundled with services. So typically to the lower cost generic products, again, that are rolled in with the whole service for the application of the drug.