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Enhanced Ambulatory Patient Groupings (EAPG)

Wellmark Blue Cross and Blue Shield reimburses most outpatient facility services using Enhanced Ambulatory Patient Groupings (EAPG) payment methodology.

The EAPG payment impacts outpatient services submitted by the following Wellmark contracting providers:

• hospitals
• ambulatory surgery centers
• renal dialysis centers
• freestanding substance abuse facilities
• skilled nursing facilities

Learn About

• EAPG Common Coding Concerns
• EAPG Reference Guide
• New Message Codes  
• Qualifying Diagnosis Codes for Mental Health and Substance Abuse Per Diem Services  
• Revenue Codes Requiring CPT/HCPCS Codes  

Patient Education

• Paying Greater Than Charge 

EAPG Webinar Documents

• April 16, 2009 – Basics of New Outpatient Payment System 
• April 28, 2009 – Refresher and Policy Update 
• December 17, 2009 – Billing Requirements and Financial Impact Analysis 
  • Q&A from December 17, 2009, Webinar 
• September 17, 2010 - EAPG Implementation Reminders, Updates  
  • Q&A from September 17, 2010, Webinar 

• May 9, 2012 – Overview of Enhanced Ambulatory Payment Groupings (EAPG) 

  • QA from May 9, 2012 webinar