Outpatient prospective payment system/ambulatory payment classifications

Kaiser Permanente adheres to the Center for Medicare & Medicaid Services (CMS) outpatient prospective payment system/ambulatory payment classifications (OPPS/APC) for outpatient facility service billing requirements. We ask that hospitals submit OPPS/APC data for non-Medicare as well as Medicare claims.

We require that you bill modifier SG for facility charges on your CMS-1500 forms, even though CMS no longer requires it.

We must capture the data requirements listed in NPI and Taxonomy Requirements and General Medicare Data Requirements to meet CMS encounter data requirements. Please refer to UB-04 (CMS-1450) required fields (PDF) for field designations.