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2025B Ambulatory Payment Classification: 5116
Title: Level 6 Musculoskeletal Procedures
| 2025B Relative Weight: | 206.2381 |
| 2025B Payment Rate: | $18390.05 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $3678.01 |
Addendum D1 Information
Status Indicator: J1
Item / Code / Service:
Hospital Part B services paid through a comprehensive APC
OPPS Payment Status:
Paid under OPPS; all covered Part B services on the claim are packaged with the primary "J1" service for the claim, except services with OPPS SI=F,G, H, L and U; ambulance services; diagnostic and screening mammography; all preventive services; and certain Part B inpatient services.
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| 2021 Top 10 OPPS Facility Claims for APC 5116* |
| NPI | Organization | APC 5116 Submitted |
| 1114265519 |
PRECISION AMBULATORY SURGERY CENTER LLC-BEVERLY HILLS-CA
|
XXX
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| 1891799227 |
NORTON HOSPITALS, INC-CHICAGO-IL
|
XXX
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| 1396792032 |
RIVER OAKS HOSPITAL LLC-FLOWOOD-MS
|
XX
|
| 1992707228 |
SHANNON MEDICAL CENTER-SAN ANGELO-TX
|
XX
|
| 1447221056 |
THE HEALTH CARE AUTHORITY OF THE CITY OF HUNTSVILLE-HUNTSVILLE-AL
|
XX
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| 1033102942 |
CARILION MEDICAL CENTER-ROANOKE-VA
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XX
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| 1376139139 |
NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLC-WINSTON SALEM-NC
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XX
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| 1134194038 |
CHRISTIANA CARE HEALTH SERVICES, INC.-NEWARK-DE
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XX
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| 1780635078 |
FLAGSTAFF MEDICAL CENTER-FLAGSTAFF-AZ
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XX
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| 1518065523 |
SSM REGIONAL HEALTH SERVICES-JEFFERSON CITY-MO
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XX
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* Medicare Part A utilization data is derived from the 100% 2021 Outpatient (Fee-for-Service) Standard Analytical File.
Procedure Codes in this APC:
20696 App mltpln uni xtrnl fix 1st
21243 Reconstruction of jaw joint
22612 Arthrd pst tq 1ntrspc lumbar
22630 Arthrd pst tq 1ntrspc lum
22633 Arthrd cmbn 1ntrspc lumbar
22856 Tot disc arthrp 1ntrspc crv
22867 Insj stablj dev w/dcmprn
23472 Reconstruct shoulder joint
23616 Optx prx hmrl fx fix rpr rpl
24361 Reconstruct elbow joint
24363 Replace elbow joint
24371 Revise reconst elbow joint
25442 Arthrp w/prostc dstl ulna
25446 Arthrp w/prostc dst rds&crps
27278 Arthrd si jt prq wo tfxj dev
27279 Arthrd si jt perq/min nvas
27702 Reconstruct ankle joint
28705 Arthrodesis pantalar
C8003 Imp extar knee shck absrb
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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.
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