Outpatient Hospital


Ambulatory Payment Classification (APC)

Iowa Medicaid uses the Ambulatory Payment Classifications (APC) methodology to reimburse for prospective payment system (PPS) outpatient hospital services.  The following documents outline the Iowa Medicaid coverage of services, APC groups, fee schedule payment rates, maximum units, discounting and packaging formulas, and the Outpatient Code Editor (OCE) edits used for claims processing.