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2025B Ambulatory Payment Classification: 5432
Title: Level 2 Nerve Procedures
| 2025B Relative Weight: | 71.8195 |
| 2025B Payment Rate: | $6404.07 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $1280.82 |
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 5432* |
| NPI | Organization | APC 5432 Submitted |
| 1871543215 |
STANFORD HEALTH CARE-STANFORD-CA
|
XX
|
| 1023049236 |
THE GENERAL HOSPITAL CORPORATION-SOMERVILLE-MA
|
XX
|
| 1801992631 |
NYU LANGONE HOSPITALS-NEW YORK-NY
|
XX
|
| 1215916002 |
THOMAS JEFFERSON UNIVERSITY HOSPITALS INC-PHILADELPHIA-PA
|
XX
|
| 1841266194 |
MAYO CLINIC HOSPITAL-ROCHESTER-ROCHESTER-MN
|
XX
|
| 1649299827 |
BARNES JEWISH HOSPITAL-SAINT LOUIS-MO
|
XX
|
| 1780630608 |
RECTOR & VISITORS OF THE UNIVERSITY OF VIRGINIA-CHARLOTTESVILLE-VA
|
XX
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| 1699874248 |
SHANDS TEACHING HOSPITAL AND CLINICS, INC.-GAINESVILLE-FL
|
XX
|
| 1689772592 |
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO-SAN FRANCISCO-CA
|
XX
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| 1649259656 |
UNIVERSITY OF KANSAS HOSPITAL AUTHORITY-WESTWOOD-KS
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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:
0269T Rev/remvl crtd sns dev total
0442T Abltj perc plex/trncl nrv
61215 Ins subq rsvr pmp/nfs sys
61720 Incise skull/brain surgery
61770 Incise skull for treatment
62225 Replace/irrigate catheter
62230 Replace/revise brain shunt
62350 Implant spinal canal cath
62365 Remove spine infusion device
63741 Install spinal shunt
63744 Revision of spinal shunt
64570 Remove vagus n eltrd
64584 Rmvl hpglsl nstim ary pg
64786 Remove sciatic nerve lesion
64792 Removal of nerve lesion
64834 Repair of hand or foot nerve
64835 Repair of hand or foot nerve
64836 Repair of hand or foot nerve
64840 Repair of leg nerve
64856 Repair/transpose nerve
64857 Repair arm/leg nerve
64862 Repair of low back nerves
64864 Repair of facial nerve
64865 Repair of facial nerve
64885 Nerve graft head/neck <4 cm
64886 Nerve graft head/neck >4 cm
64890 Nrv grf 1strnd hnd/foot <4cm
64891 Nrv grf 1strnd hnd/foot >4cm
64892 Nrv grf 1strnd arm/leg <4cm
64893 Nrv grf 1strnd arm/leg >4 cm
64895 Nrv grf mltst hnd/foot <4 cm
64896 Nrv grf mltst hnd/foot >4 cm
64897 Nrv grf mltst arm/leg <4 cm
64898 Nrv grf mltst arm/leg >4 cm
64905 Nerve pedicle transfer
64907 Nerve pedicle transfer
64910 Nerve repair w/allograft
64911 Neurorraphy w/vein autograft
64912 Nrv rpr w/nrv algrft 1st
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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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