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2025B Ambulatory Payment Classification: 5302
Title: Level 2 Upper GI Procedures
| 2025B Relative Weight: | 21.2741 |
| 2025B Payment Rate: | $1896.99 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $379.40 |
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 5302* |
| NPI | Organization | APC 5302 Submitted |
| 1841266194 |
MAYO CLINIC HOSPITAL-ROCHESTER-ROCHESTER-MN
|
X,XXX
|
| 1306938071 |
ADVENTIST HEALTH SYSTEM-SUNBELT, INC-ALTAMONTE SPRINGS-FL
|
X,XXX
|
| 1174582050 |
UNIVERSITY OF TEXAS M. D. ANDERSON CANCER CENTER-HOUSTON-TX
|
XXX
|
| 1679525919 |
THE CLEVELAND CLINIC FOUNDATION-CLEVELAND-OH
|
XXX
|
| 1548202641 |
BETH ISRAEL DEACONESS MEDICAL CENTER, INC.-BOSTON-MA
|
XXX
|
| 1497859649 |
NORTHWESTERN MEMORIAL HEALTHCARE-CHICAGO-IL
|
XXX
|
| 1891782470 |
MAYO CLINIC FLORIDA-JACKSONVILLE-FL
|
XXX
|
| 1023049236 |
THE GENERAL HOSPITAL CORPORATION-SOMERVILLE-MA
|
XXX
|
| 1871543215 |
STANFORD HEALTH CARE-STANFORD-CA
|
XXX
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| 1396882205 |
VANDERBILT UNIVERSITY MEDICAL CENTER-NASHVILLE-TN
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XXX
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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:
0647T Insj gtube perq mag gastrpxy
0652T Egd flx transnasal dx br/wa
0653T Egd flx transnasal bx 1/mlt
32556 Insert cath pleura w/o image
43191 Esophagoscopy rigid trnso dx
43192 Esophagoscp rig trnso inject
43193 Esophagoscp rig trnso biopsy
43194 Esophagoscp rig trnso rem fb
43196 Esophagoscp guide wire dilat
43201 Esoph scope w/submucous inj
43202 Esophagoscopy flex biopsy
43204 Esoph scope w/sclerosis inj
43205 Esophagus endoscopy/ligation
43206 Esoph optical endomicroscopy
43211 Esophagoscop mucosal resect
43213 Esophagoscopy retro balloon
43214 Esophagosc dilate balloon 30
43215 Esophagoscopy flex remove fb
43216 Esophagoscopy lesion removal
43217 Esophagoscopy snare les remv
43220 Esophagoscopy balloon <30mm
43226 Esoph endoscopy dilation
43227 Esophagoscopy control bleed
43231 Esophagoscop ultrasound exam
43232 Esophagoscopy w/us needle bx
43233 Egd balloon dil esoph30 mm/>
43237 Endoscopic us exam esoph
43238 Egd us fine needle bx/aspir
43241 Egd tube/cath insertion
43242 Egd us fine needle bx/aspir
43243 Egd injection varices
43244 Egd varices ligation
43245 Egd dilate stricture
43246 Egd place gastrostomy tube
43249 Esoph egd dilation <30 mm
43250 Egd cautery tumor polyp
43251 Egd remove lesion snare
43252 Egd optical endomicroscopy
43253 Egd us transmural injxn/mark
43254 Egd endo mucosal resection
43255 Egd control bleeding any
43259 Egd us exam duodenum/jejunum
43263 Ercp sphincter pressure meas
43270 Egd lesion ablation
43275 Ercp remove forgn body duct
43290 Egd flx trnsorl dplmnt balo
43453 Dilate esophagus
43830 Gstrst open wo constj tube
44360 Small bowel endoscopy
44361 Small bowel endoscopy/biopsy
44363 Small bowel endoscopy
44364 Small bowel endoscopy
44365 Small bowel endoscopy
44366 Small bowel endoscopy
44369 Small bowel endoscopy
44372 Small bowel endoscopy
44373 Small bowel endoscopy
44376 Small bowel endoscopy
44377 Small bowel endoscopy/biopsy
44378 Small bowel endoscopy
44381 Small bowel endoscopy br/wa
44384 Small bowel endoscopy
49423 Exchange drainage catheter
49436 Embedded ip cath exit-site
49440 Place gastrostomy tube perc
49441 Place duod/jej tube perc
49446 Change g-tube to g-j perc
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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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