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CMS/NCCI designation for C-Code reimbursement

Beginning May 15, 2023, PacificSource Health Plans will use the CMS/National Correct Coding Initiative (NCCI) designation for the consideration of C-code reimbursements.

  • C-codes with a dollar amount assigned are eligible for reimbursement at the contracted benefit level.
  • C-codes with no dollar amount assigned are not eligible for separate reimbursement, as they are considered “bundled” services.

For more information, visit the Addendum A and Addendum B Updates on the, Hospital Outpatient Prospective Payment System (OPPS) website.