Average payment for the service in a locality under the current system. AHPB is based on the average prevailing charge Medicare paid all physicians in a particular geographic area for a specific service. “Adjusted” means reduced by a percent to ensure that the fee schedule phase-in is budget neutral. Medicare carriers used ADPBs to figure blended payment rates during the transition period before implementation of the RBRVS system of payment.

Amount of money that the Centers for Medicare and Medicaid Services will pay Medicare risk health maintenance organizations (HMOs) to cover a Medicare beneficiary. The rate is taken from the adjusted average per capita cost (AAPCC) based on health risk factors for the beneficiaries.

Special codes used by insurance carriers to explain the reason an insurance claim or a medical service was paid differently than the billed amount.

Reference list of coded explanations of changes made to a paid insurance claim. The codes detail and clarify all services reported and eliminate having to generate a separate letter of explanation.

Changes or modifications to the base payment rates to allow for differences in providers’ situations that affect their costs of giving medical services. These adjustments are to accommodate differences in local prices for products and services, delivery of specialized types of care, or atypical characteristics of beneficiaries.

Additional technique(s) that may be required at the time a bypass graft is created to improve patency of the lower extremity autogenous or synthetic bypass graft or fistula. Use of CPT codes 35685 and 35686 are add-on codes and should be reported with a code for the primary procedure performed.