|
|
.
2025B Ambulatory Payment Classification: 5053
Title: Level 3 Skin Procedures
| 2025B Relative Weight: | 6.8648 |
| 2025B Payment Rate: | $612.13 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $122.43 |
Addendum D1 Information
Status Indicator: T
Item / Code / Service:
Procedure or Service, Multiple Procedure Reduction Applies
OPPS Payment Status:
Paid under OPPS; Separate APC payment.
|
| 2021 Top 10 OPPS Facility Claims for APC 5053* |
| NPI | Organization | APC 5053 Submitted |
| 1851370910 |
TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA-PHILADELPHIA-PA
|
X,XXX
|
| 1679525919 |
THE CLEVELAND CLINIC FOUNDATION-CLEVELAND-OH
|
X,XXX
|
| 1922043744 |
UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY-MIDDLETON-WI
|
X,XXX
|
| 1396882205 |
VANDERBILT UNIVERSITY MEDICAL CENTER-NASHVILLE-TN
|
X,XXX
|
| 1568460772 |
AVERA MCKENNAN-MINNEAPOLIS-MN
|
X,XXX
|
| 1801851258 |
VIRGINIA MASON MEDICAL CENTER-LOS ANGELES-CA
|
X,XXX
|
| 1841266194 |
MAYO CLINIC HOSPITAL-ROCHESTER-ROCHESTER-MN
|
X,XXX
|
| 1871543215 |
STANFORD HEALTH CARE-STANFORD-CA
|
X,XXX
|
| 1821017880 |
SANFORD MEDICAL CENTER-SIOUX FALLS-SD
|
X,XXX
|
| 1528009412 |
SANFORD MEDICAL CENTER FARGO-FARGO-ND
|
X,XXX
|
* Medicare Part A utilization data is derived from the 100% 2021 Outpatient (Fee-for-Service) Standard Analytical File.
Procedure Codes in this APC:
0419T Dstrj neurofibroma xtnsv
0420T Dstrj neurofibroma xtnsv
0479T Fxjl abl lsr 1st 100 sq cm
11000 Dbrdmt ecz/infected skin<10%
11043 Dbrdmt musc&/fsca 1st 20/<
11106 Incal bx skn single les
11760 Repair of nail bed
11920 Correct skin color 6.0 cm/<
11921 Correct skn color 6.1-20.0cm
11951 Tx contour defects 1.1-5.0cc
11952 Tx contour defects 5.1-10cc
11954 Tx contour defects >10.0 cc
12020 Tx supfc wnd dehsn smpl clsr
12036 Intmd rpr s/a/t/ext 20.1-30
12044 Intmd rpr n-hf/genit7.6-12.5
12045 Intmd rpr n-hf/genit12.6-20
12046 Intmd rpr n-hf/genit20.1-30
13100 Cmplx rpr trunk 1.1-2.5 cm
13101 Cmplx rpr trunk 2.6-7.5 cm
13120 Cmplx rpr s/a/l 1.1-2.5 cm
13121 Cmplx rpr s/a/l 2.6-7.5 cm
13132 Cmplx rpr f/c/c/m/n/ax/g/h/f
13151 Cmplx rpr e/n/e/l 1.1-2.5 cm
13152 Cmplx rpr e/n/e/l 2.6-7.5 cm
15004 Wound prep f/n/hf/g
15050 Pinch graft up to 2 cm diam
15789 Chemical peel facial dermal
15792 Chem peel nonfacial epidrm
15852 Dressing change not for burn
17107 Destruction of skin lesions
17284 Dstr mal ls f/e/e/n/l/m3.1-4
17286 Dstr mal ls f/e/e/n/l/m>4.0
17311 Mohs 1 stage h/n/hf/g
17313 Mohs 1 stage t/a/l
17380 Electrolysis epilation ea 30
20910 Remove cartilage for graft
C5271 Low cost skin substitute app
C5275 Low cost skin substitute app
C5277 Low cost skin substitute app
|
Sources: Updates of Addendum A and B are posted quarterly to the OPPS website. These addenda are a "snapshot" of HCPCS codes and their status indicators,
APC groups, and OPPS payment rates, that are in effect at the beginning of each quarter. The quarterly updates of Addendum A and Addendum B reflect
the OPPS Pricer changes that are part of the quarterly OPPS recurring update notification transmittals.
http://www.cms.gov/HospitalOutpatientPPS/AU/list.asp#TopOfPage
For more information on the Composite APC payment,
please see CMS Transmittal R2141CP.
|
|
