Ambulatory Payment Classifications (APC) Claims Overpaying, CR 114133

Dec 22, 2022

Some Ambulatory Payment Classifications (APC) claims are overpaying when COVID-19 administration codes are billed in addition to an office visit (i.e., HCPC G0643). The COVID-19 administration code is paying 100% of APC accurately, and the office visit code is paying 100% of APC in error. MaineCare is responsible for paying 100% of APC only on the COVID-19 administration codes. We will notify you once the system is updated. No provider action is needed. Claims that overpaid incorrectly will be adjusted.