Outpatient Prospective Payment System (OPPS) Information

Hospital Outpatient PPS
This area provides resources to Medicare-based OPPS information which may assist providers in better understanding Wyoming Medicaid OPPS priced claims.

Hospital Outpatient PPS Transmittals
This area provides quarterly updates to the Outpatient Code Editor (OCE) software for OPPS modifications. When searching quarterly transmittals, please note that
Appendix M: Summary of Modifications resources can be found for the following subjects:

  • Diagnosis Code Changes
  • Status Indicator Changes
  • HCPCS changes
  • Composite Ambulatory Payment Classifications (APCs)

Note: Transmittals are not always a direct crosswalk to Wyoming Medicaid. These are reflections of CMS Manual changes, whereby, Wyoming Medicaid may opt to modify certain aspects therein.

National Correct Coding Initiative (NCCI) Edits – Hospital PPS
This area provides reviews of mutually exclusive and incompatible code combinations

OPPS Table Legend

 
APC-Based Fee Schedule Effective Date Wyoming Medicaid Implementation Date
APC-Based Fee Schedule 4.1.22 (Excel Ver) 4/1/22 4/1/22
APC-Based Fee Schedule 1.1.22 (Excel Ver) 1/1/22 1/1/22
APC-Based Fee Schedule 10.1.21 (Excel Ver) 10/1/21 10/1/21
APC-Based Fee Schedule 4.1.21 (Excel Ver) 4/1/21 7/1/21
APC-Based Fee Schedule 1.1.21 (Excel Ver) 1/1/21 4/1/21
APC-Based Fee Schedule 10.1.20 (Excel Ver) 10/1/20 1/1/21
APC-Based Fee Schedule 7.1.20 (Excel Ver) 7/1/20 10/1/20
APC-Based Fee Schedule 4.1.20 (Excel Ver) 4/1/20 7/1/20
APC-Based Fee Schedule 1.1.20 (Excel Ver) 1/1/2020 4/1/2020
APC-Based Fee Schedule 10.1.19 (Excel Ver) 10/1/19 1/1/20
APC-Based Fee Schedule 7.1.19 (Excel Ver) 7/1/19 10/1/19
APC-Based Fee Schedule 4/1/19 (Excel Ver) 4/1/19 7/1/19
APC-Based Fee Schedule 1/1/19 (Excel Ver) 1/1/19 4/1/19
APC-Based Fee Schedule 10/1/18 (Excel Ver) 10/1/18 1/1/19
APC-Based Fee Schedule 7/1/18 (Excel Ver) 7/1/18 10/1/18
APC-Based Fee Schedule 4/1/2018 (Excel Ver) 4/1/18 7/1/18
APC-Based Fee Schedule 1/1/2018 (Excel Ver) 1/1/18 4/1/18
APC-Based Fee Schedule 10/1/2017 (Excel Ver    
APC-Based Fee schedule 7/01/17 (Excel Ver)    
APC-Based Fee Schedule 4/01/17 (Excel Ver)    
APC-Based Fee Schedule 1/01/17 - Updated (Excel Ver)    
APC-Based Fee Schedule 11/01/16 -Updated (Excel Ver) 11/01/2016 - 3/31/2017 1/1/2017 - 3/31/2017
APC-Based Fee Schedule 11/01/2016 (Excel Ver) 11/01/2016 - 12/31/2016 11/01/2016 - 12/31/2016
APC-Based Fee Schedule 10/01/16 - Updated 10/1/2016 - 10/31/2016 1/1/2017 - 3/31/2017
APC-Based Fee Schedule 10/01/2016 (Excel Ver) 07/01/2016 - 10/31/2016 10/01/2016 - 12/31/2016
APC-Based Fee Schedule 7/1/2016 Updated (Excel Ver) Updated 9/29/16    
APC-Based Fee Schedule 4/1/2016 (Excel Ver)    
APC-Based Fee Schedule 1/4/2016 (Excel Ver)    
APC-Based Fee Schedule 7/1/2015 (Excel Ver)    
APC-Bases Fee Schedule 4/1/2015 (Excel Ver)    
APC-Based Fee Schedule 1/1/2015 (Excel Ver)    
APC-Based Fee Schedule 10/1/2014 (Excel Ver)    
APC-Based Fee Schedule 7/1/2014 (Excel Ver)    
APC-Based Fee Schedule 4/1/2014 (Excel Ver)    
APC-Based Fee Schedule 1/1/2014 (Excel Ver)    
APC-Based Fee Schedule 10/1/2013 (Excel Ver)    
APC-Based Fee Schedule 7/1/2013 (Excel Ver)