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2025B Ambulatory Payment Classification: 5415
Title: Level 5 Gynecologic Procedures
| 2025B Relative Weight: | 55.3606 |
| 2025B Payment Rate: | $4936.45 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $987.29 |
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 5415* |
| NPI | Organization | APC 5415 Submitted |
| 1386608859 |
HONORHEALTH-SCOTTSDALE-AZ
|
XXX
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| 1922043744 |
UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY-MIDDLETON-WI
|
XXX
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| 1821017880 |
SANFORD MEDICAL CENTER-SIOUX FALLS-SD
|
XX
|
| 1780630608 |
RECTOR & VISITORS OF THE UNIVERSITY OF VIRGINIA-CHARLOTTESVILLE-VA
|
XX
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| 1871543215 |
STANFORD HEALTH CARE-STANFORD-CA
|
XX
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| 1134194038 |
CHRISTIANA CARE HEALTH SERVICES, INC.-NEWARK-DE
|
XX
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| 1992703540 |
DUKE UNIVERSITY HEALTH SYSTEM, INC.-DURHAM-NC
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XX
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| 1376544320 |
STATE UNIVERSITY OF IOWA-IOWA CITY-IA
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XX
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| 1386241834 |
LEXINGTON HEALTH INC-WEST COLUMBIA-SC
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XX
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| 1003878539 |
REGENTS OF THE UNIVERSITY OF MICHIGAN-ANN ARBOR-MI
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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:
51845 Repair bladder neck
55920 Place needles pelvic for rt
55970 Sex transformation m to f
57020 Colpocentesis sep px
57120 Colpocleisis le fort type
57155 Insert uteri tandem/ovoids
57220 Revision of urethra
57240 Anterior colporrhaphy
57250 Repair rectum & vagina
57260 Cmbn ant pst colprhy
57265 Cmbn ap colprhy w/ntrcl rpr
57268 Repair of bowel bulge
57284 Repair paravag defect open
57288 Repair bladder defect
57291 Construction of vagina
57292 Construct vagina with graft
57320 Repair bladder-vagina lesion
57335 Repair vagina
57530 Removal of cervix
57550 Removal of residual cervix
57555 Remove cervix/repair vagina
57556 Remove cervix repair bowel
58260 Vaginal hysterectomy
58262 Vag hyst including t/o
58263 Vag hyst w/t/o & vag repair
58270 Vag hyst w/enterocele repair
58291 Vag hyst incl t/o complex
58294 Vag hyst w/enterocele compl
58346 Insert heyman uteri capsule
58350 Reopen fallopian tube
58353 Endometr ablate thermal
58356 Endometrial cryoablation
58559 Hysteroscopy lysis
58560 Hysteroscopy resect septum
58561 Hysteroscopy remove myoma
58563 Hysteroscopy ablation
58565 Hysteroscopy sterilization
58925 Removal of ovarian cyst(s)
59100 Remove uterus lesion
C9778 Colpopexy, min/inv, ex-perit
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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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