APC Packager/Pricer

Ambulatory Payment Classifications (APC) are Medicare's method of paying for facility outpatient services. The Federal Balanced Budget Act of 1997 instructed the Centers for Medicare and Medicaid Services (CMS) to create OPPS, the Outpatient Prospective Payment System for hospital outpatient services - similar to DRGs (Diagnosis-Related Groups) for hospital inpatients. APCs are only used in hospitals.

When the Medicare outpatient is discharged from the Emergency Department or clinic or is transferred to another hospital (or other facility) which is not affiliated with the initial hospital where the patient received outpatient services, an APC payment is made to the initial hospital. For patients admitted from an emergency department or hospital clinic there is no APC payment. Instead Medicare pays the hospital under the inpatient DRG methodology.

To use this calculator...