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*Cook’s policy is to offer only information that is complete, accurate, straightforward, and consistent with the statutes and regulations of the federal government and well-accepted coding guidelines as established by the Centers for Medicare and Medicaid Services (“CMS”), the American Medical Association (“AMA”), the American Hospital Association (“AHA”), and other relevant professional societies.
Several years ago Medicare implemented the OPPS (Outpatient Prospective Payment System) to pay hospitals for services provided in their outpatient departments. This system includes billing codes called “C-codes,” or “pass-through” codes. Medicare created more than 90 pass-through categories of devices and gave each category its own C-code (the letter “C” followed by four digits). If a hospital used a device that belongs to a pass-through category, it could put the appropriate C-code on the bill that it submitted to Medicare and receive an additional payment. These were commonly known as pass-through payments and were designed to expire after two to three years, after which the additional payments would be folded into the relevant Ambulatory Payment Classification (APC) payment rates.
Though the pass-through payments for most C-codes no longer exist, Medicare does require that C-codes continue to be included on hospital claims paid under the OPPS. This is done so that Medicare can adequately capture the resources required to provide services and can use this resource information to establish adequate payment rates in the future. In fact, Medicare has defined certain procedures as being device dependent, and claims for these procedures will be denied if they don’t also include the necessary C-code. See http://www.cms.hhs.gov/HospitalOutpatientPPS for additional information.