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2026A Ambulatory Payment Classification: 5433
Title: Level 3 Nerve Procedures
| 2026A Relative Weight: | 98.0794 |
| 2026A Payment Rate: | $8965.93 |
| 2026A National Unadjusted Copay: | $ 0.00 |
| 2026A Minimum Unadjusted Copay: | $1793.19 |
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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* Medicare Part A utilization data is derived from the 100% 2021 Outpatient (Fee-for-Service) Standard Analytical File.
Procedure Codes in this APC:
0442T Abltj perc plex/trncl nrv
61215 Ins subq rsvr pmp/nfs sys
61720 Incise skull/brain surgery
62230 Replace/revise brain shunt
62350 Implant spinal canal cath
63741 Install spinal shunt
64840 Repair of leg nerve
64856 Repair/transpose nerve
64864 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
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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