Never Pay APGs Under APG Reimbursement
Revised for July 1, 2021 Updates:
- Also available in Excel Format (XLS) and Portable Document Format (PDF)
Note: Information revised during the quarterly update period stated above is highlighted.
| APG | APG Desc | APG Type | Alternative Payment Available1 |
Date added to Never Pay List |
Date Removed from Never Pay List |
|---|---|---|---|---|---|
| 65 | RESPIRATORY THERAPY | Diagnostic or Therapeutic Proc | No | 12/1/2008 | 7/1/2021 |
| 66 | PULMONARY REHABILITATION | Physical Therapy & Rehab | Yes/No2 | 12/1/2008 | |
| 94 | CARDIAC REHABILITATION | Physical Therapy & Rehab | No | 12/1/2008 | 1/1/2010 |
| 102 | CONSULTATIVE TELEHEALTH ASSESSMENTS MEDICAL VISIT INDICATOR | Incidental | No | 1/1/2020 | |
| 117 | HOME INFUSION | Diagnostic or Therapeutic Proc | No | 12/1/2008 | |
| 118 | NUTRITION THERAPY | Physical Therapy & Rehab | No | 12/1/2008 | 1/1/2010 |
| 157 | REPRODUCTIVE PATHOLOGY TESTS | Ancillary | No | 7/1/2021 | |
| 190 | ARTIFICIAL FERTILIZATION | Diagnostic or Therapeutic Proc | No | 12/1/2008 | |
| 246 | CLASS IV THERAPEUTIC RADIOPHARMACEUTICALS | Drug | Yes | 1/1/2020 | |
| 311 | FULL DAY PARTIAL HOSPITALIZATION FOR SUBSTANCE ABUSE | Per Diem | No | 12/1/2008 | 1/1/2020 |
| 312 | BEHAVIORAL AND SUBSTANCE ABUSE PARTIAL HOSPITALIZATION PROGRAM | Per Diem | No | 12/1/2008 | 7/1/2010 |
| 313 | Half Day Partial Hospitalization For Substance Abuse | Per Diem | No | 12/1/2008 | 1/1/2019 |
| 314 | Half Day Partial Hospitalization For Mental Illness | Per Diem | No | 12/1/2008 | 1/1/2019 |
| 319 | ACTIVITY THERAPY | Behavioral Health & Counseling | No | 12/1/2008 | |
| 320 | BEHAVIORAL HEALTH – CASE MANAGEMENT AND TREATMENT PLAN DEVELOPMENT | Behavioral Health & Counseling | No | 12/1/2008 | 7/1/2010 |
| 326 | OPIOID TREATMENT PROGRAM SERVICES | Significant Procedure | No | 1/1/2020 | 7/1/2021 |
| 371 | LEVEL I ORTHODONTICS | Dental Procedure | Yes – carve out | 12/1/2008 | |
| 385 | LEVEL I MOLECULAR PATHOLOGY AND GENETIC TESTS | Ancillary | Yes/No – carve out2 | 1/1/2016 | |
| 386 | LEVEL II MOLECULAR PATHOLOGY AND GENETIC TESTS | Ancillary | Yes/No – carve out2 | 1/1/2016 | |
| 387 | LEVEL III MOLECULAR PATHOLOGY AND GENETIC TESTS | Ancillary | Yes/No – carve out2 | 1/1/2016 | |
| 427 | BIOFEEDBACK AND OTHER TRAINING | Ancillary | No | 12/1/2008 | 7/1/2010 |
| 430 | CLASS I CHEMOTHERAPY DRUGS | Drug | Yes – carve out | 12/1/2008 | |
| 431 | CLASS II CHEMOTHERAPY DRUGS | Drug | Yes – carve out | 12/1/2008 | |
| 432 | CLASS III CHEMOTHERAPY DRUGS | Drug | Yes – carve out | 12/1/2008 | |
| 433 | CLASS IV CHEMOTHERAPY DRUGS | Drug | Yes – carve out | 12/1/2008 | |
| 434 | CLASS V CHEMOTHERAPY DRUGS | Drug | Yes – carve out | 12/1/2008 | |
| 441 | CLASS VI CHEMOTHERAPY DRUGS | Drug | Yes – carve out | 1/1/2010 | |
| 442 | Class VII Combined Chemotherapy & Pharmacotherapy | Drug | No | 1/1/2010 | 1/1/2011 |
| 443 | CLASS VII CHEMOTHERAPY DRUGS | Drug | Yes – carve out | 1/1/2011 | |
| 450 | OBSERVATION | Ancillary | No | 12/1/2008 | 1/1/2011 |
| 452 | DIABETES SUPPLIES | DME | Yes – carve out | 12/1/2008 | |
| 453 | MOTORIZED WHEELCHAIR | DME | Yes – carve out | 12/1/2008 | |
| 454 | TPN FORMULAE | DME | Yes – carve out | 12/1/2008 | |
| 456 | MOTORIZED WHEELCHAIR ACCESSORIES | DME | Yes – carve out | 12/1/2008 | |
| 459 | VACCINE ADMINISTRATION | Ancillary | No | 7/1/2017 | |
| 465 | CLASS XIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY | Drug | Yes – carve out | 7/1/2011 | |
| 466 | CLASS XIV COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY | Drug | Yes – carve out | 7/1/2021 | |
| 492 | Direct Admission For Observation Indicator | Incidental | No | 12/1/2008 | 1/1/2011 |
| 495 | MINOR CHEMOTHERAPY DRUGS | Drug | Yes – carve out | 7/1/2012 | |
| 500 | Direct Admission For Observation – Obstetrical | Medical Visit | No | 12/1/2008 | 1/1/2011 |
| 501 | Direct Admission For Observation – Other Diagnoses | Medical Visit | No | 12/1/2008 | 1/1/2011 |
| 999 | UNASSIGNED | Unassigned | No | 12/1/2008 | |
| 2000 | DIAGNOSTIC RADIOPHARMACEUTICAL | Incidental | No | 1/1/2020 | |
| 2001 | DIAGNOSTIC CONTRAST MEDIA | Incidental | No | 1/1/2020 | |
| 2002 | INCIDENTAL IMAGING SERVICES | Incidental | No | 1/1/2020 | |
| 2003 | INCIDENTAL PHYSICIAN REPORT OR TECHNICAL SERVICES | Incidental | No | 1/1/2020 | |
| 2004 | INCIDENTAL MINOR DIAGNOSTIC TESTS | Incidental | No | 1/1/2020 | |
| 2005 | INCIDENTAL MEDICAL VISIT SERVICES | Incidental | No | 1/1/2020 | |
| 2006 | INCIDENTAL IMPLANTABLE OR OTHER RELATED DEVICES | Incidental | No | 1/1/2020 | |
| 2007 | INCIDENTAL BEHAVIORAL HEALTH SERVICES | Incidental | No | 1/1/2020 |
1. APGs listed as carve outs should not be billed using APGs. Indication as a carve out does not guarantee alternative payment. 1
2. Refer to "Never Pay Procedures" list to verify whether a procedure of APG 385 has alternative payment available or not. 2
