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2025B Ambulatory Payment Classification: 5463
Title: Level 3 Neurostimulator and Related Procedures
| 2025B Relative Weight: | 139.8503 |
| 2025B Payment Rate: | $12470.31 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $2494.07 |
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 5463* |
| NPI | Organization | APC 5463 Submitted |
| 1972001469 |
NOVANT HEALTH MINT HILL MEDICAL CENTER, LLC-WINSTON SALEM-NC
|
XX
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| 1063489342 |
THE PENNSYLVANIA HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYS-PHILADELPHIA-PA
|
XX
|
| 1932213600 |
RUSH UNIVERSITY MEDICAL CENTER-CHICAGO-IL
|
XX
|
| 1649259656 |
UNIVERSITY OF KANSAS HOSPITAL AUTHORITY-WESTWOOD-KS
|
XX
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| 1821074196 |
BOULDER COMMUNITY HEALTH-BOULDER-CO
|
XX
|
| 1790717650 |
BRIGHAM & WOMENS HOSPITAL, INC.-SOMERVILLE-MA
|
XX
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| 1780630608 |
RECTOR & VISITORS OF THE UNIVERSITY OF VIRGINIA-CHARLOTTESVILLE-VA
|
XX
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| 1497702575 |
ORANGE COAST MEMORIAL MEDICAL CENTER-FOUNTAIN VALLEY-CA
|
XX
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| 1144213117 |
SHELBY COUNTY HEALTH CARE CORPORATION-MEMPHIS-TN
|
XX
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| 1306938071 |
ADVENTIST HEALTH SYSTEM-SUNBELT, INC-ALTAMONTE SPRINGS-FL
|
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:
0675T Laps insj nw/rpcmt isdss 1ld
0784T Ins/rplmt eltrd ra spi nstim
33288 Rmv&rplcmt phrnc nrv stim ld
43647 Lap impl electrode antrum
61715 Mrgfus strtctc ablt trgt icr
61888 Revise/remove neuroreceiver
63664 Revise spine eltrd plate
64553 Implant neuroelectrodes
64569 Revise/repl vagus n eltrd
64575 Opn impltj nea perph nerve
64583 Rev/rplct hpglsl nstm ary pg
64596 Ins/rplcmt prq eltrd ra pn 1
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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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