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2025B Ambulatory Payment Classification: 5166
Title: Cochlear Implant Procedure
| 2025B Relative Weight: | 356.7139 |
| 2025B Payment Rate: | $31807.82 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $6361.57 |
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 5166* |
| NPI | Organization | APC 5166 Submitted |
| 1396882205 |
VANDERBILT UNIVERSITY MEDICAL CENTER-NASHVILLE-TN
|
XX
|
| 1639101751 |
MASSACHUSETTS EYE AND EAR INFIRMARY-BOSTON-MA
|
XX
|
| 1841266194 |
MAYO CLINIC HOSPITAL-ROCHESTER-ROCHESTER-MN
|
XX
|
| 1396790200 |
HCA HEALTHONE LLC-ENGLEWOOD-CO
|
XX
|
| 1376544320 |
STATE UNIVERSITY OF IOWA-IOWA CITY-IA
|
XX
|
| 1073605879 |
MEDICAL UNIVERSITY HOSPITAL AUTHORITY-NEW YORK-NY
|
XX
|
| 1528009412 |
SANFORD MEDICAL CENTER FARGO-FARGO-ND
|
XX
|
| 1932208576 |
UNIVERSITY OF NORTH CAROLINA HOSPITALS AT CHAPEL HILL-MORRISVILLE-NC
|
XX
|
| 1154392231 |
MAYO CLINIC ARIZONA-SCOTTSDALE-AZ
|
XX
|
| 1346251543 |
ST. LUKES EPISCOPAL-PRESBYTERIAN HOSPITAL-CHESTERFIELD-MO
|
XX
|
* Medicare Part A utilization data is derived from the 100% 2021 Outpatient (Fee-for-Service) Standard Analytical File.
Procedure Codes in this APC:
69930 Implant cochlear device
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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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