Billing of ‘C’ HCPCS Codes by Non-OPPS Providers

20.7 - Billing of ‘C’ HCPCS Codes by Non-OPPS Providers (Rev. 976, Issued: 06-09-06, Effective: 10-01-06, Implementation: 10-02-06) Prior to October 1, 2006, the “C” series of HCPCS codes were used exclusively by hospitals subject to OPPS to identify items that may have qualified for transitional pass through payment under OPPS or items or services for which an appropriate HCPCS code did not exist for the purposes of implementing the OPPS. The C-codes could not be used to bill services payable under other payment systems. CMS realized that these C-codes evolved and also target services that are uniquely hospital services that may be provided by an OPPS provider, other providers, or be paid under other payment systems. Effective October 1, 2006, the following non-OPPS providers may elect to bill using the C-codes or an appropriate CPT code on Types of Bill (TOBs) 12X, 13X, or 85X: • Critical Access Hospitals (CAHs); • Indian Health Service Hospitals (IHS); • Hospitals located in American Samoa, Guam, Saipan or the Virgin Islands; and • Maryland waiver hospitals. The OPPS providers shall continue to receive pass-through payment on items or services that qualify for pass through payment. Non-OPPS providers are not eligible for pass through payments. The C-codes shall be replaced with permanent codes. Whenever a permanent code is established to replace a temporary code, the temporary code is deleted and cross- referenced to the new permanent code. Upon deletion of a temporary code, providers shall bill using the new permanent code. Providers are encouraged to access the CMS Web site to view the quarterly HCPCS Code updates. The URL to view the quarterly updates is http://www.cms.hhs.gov/HCPCSReleaseCodeSets/. The billing of C-codes by Method I and Method II Critical Access Hospitals (CAHs) is limited to the billing for facility (technical) services. The C-codes shall not be billed by Method II CAHs for professional services with revenue codes 96X, 97X, or 98X.