CMS strives to provide its beneficiaries with access to treatment with new technologies. In the outpatient setting, Medicare supports the provision of new technology procedures through reimbursement of these services under New Technology ACPs.

What are New Technology APCs?

The Outpatient Prospective Payment System (OPPS) uses new technology APCs to pay for certain new services until CMS gathers sufficient claims data to enable it to assign the service to an appropriate clinical APC.

To be assigned to a New Technology APC, the service must meet certain criteria, including, but not limited to the following:

✔︎ The service must be truly new, meaning it cannot be appropriately reported by an existing HCPCS code assigned to a clinical APC and does not appropriately fit within an existing clinical APC.

✔︎ The service must not be eligible for transitional pass-through payment (however, a truly new, comprehensive service could qualify for assignment to a new technology APC even if it involves a device or drug that could, on its own, qualify for pass-through payment).

✔︎ The service falls within the scope of Medicare benefits.

Once assigned, a service is paid under a New Technology APC until sufficient claims data have been collected (generally two to three years) to allow CMS to assign the procedure to a clinical APC group that is appropriate in clinical and resource terms.