Can an outpatient hospital or a physician office/free-standing clinic be reimbursed by Medicare for the administration of Cathflo?
The outpatient hospital can bill Medicare using CPT code 36593 and will be paid according to Ambulatory Payment Classifications (APCs), which assign payments by groups of services that are clinically similar and require comparable resource use. Each APC is associated with a single payment rate, but a hospital may receive more than one APC payment for a single patient encounter, depending on the services provided during that visit. Reimbursement for the physician office/free-standing clinic is included in the physician payment provided under the Medicare Physician Fee Schedule, which assigns a payment rate for each CPT code.
