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New ambulatory surgical grouper policy, effective April 1, 2018

01/30/2018

Ambulatory surgical groupers will be paid according to surgical contracted rates when billed with revenue codes 360, 361, 369, 481, 490, 499 and 750. In addition, claims will be paid according to surgical contracted rates if a service in the ConnectiCare grouper list is billed with a revenue code other than those previously defined and the claim contains charges for anesthesia and recovery room.

Mapping and updated code assignments will be effective April 1, 2018 for all contracted facilities, with the exception of 2018 new codes, which are effective Jan. 1, 2018.

For contracts renewing on or before April 1, 2018, new groupers will take effect upon renewal or as otherwise negotiated.

For contracts renewing after April 1, 2018, prior to renewal, surgical codes assigned group 0 will map to contracted group 1 rates until the contract is re-negotiated to include a 0-9 group rate structure.

Here’s the 2018 ConnectiCare Surgical Groupers list.