|
|
.
2025B Ambulatory Payment Classification: 5464
Title: Level 4 Neurostimulator and Related Procedures
| 2025B Relative Weight: | 240.4915 |
| 2025B Payment Rate: | $21444.39 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $4288.88 |
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.
|
| 2021 Top 10 OPPS Facility Claims for APC 5464* |
| NPI | Organization | APC 5464 Submitted |
| 1578809430 |
UAB CALLAHAN EYE HOSPITAL AUTHORITY-BIRMINGHAM-AL
|
XXX
|
| 1538164090 |
UNIVERSITY HEALTH SYSTEM, INC.-NASHVILLE-TN
|
XXX
|
| 1649259656 |
UNIVERSITY OF KANSAS HOSPITAL AUTHORITY-WESTWOOD-KS
|
XX
|
| 1306938071 |
ADVENTIST HEALTH SYSTEM-SUNBELT, INC-ALTAMONTE SPRINGS-FL
|
XX
|
| 1073605879 |
MEDICAL UNIVERSITY HOSPITAL AUTHORITY-NEW YORK-NY
|
XX
|
| 1679525919 |
THE CLEVELAND CLINIC FOUNDATION-CLEVELAND-OH
|
XX
|
| 1568460772 |
AVERA MCKENNAN-MINNEAPOLIS-MN
|
XX
|
| 1679001028 |
CENTERVIEW SURGERY CENTER, LLC-LITTLE ROCK-AR
|
XX
|
| 1649299827 |
BARNES JEWISH HOSPITAL-SAINT LOUIS-MO
|
XX
|
| 1821017880 |
SANFORD MEDICAL CENTER-SIOUX FALLS-SD
|
XX
|
* Medicare Part A utilization data is derived from the 100% 2021 Outpatient (Fee-for-Service) Standard Analytical File.
Procedure Codes in this APC:
0680T Insj/rplcmt pg only isdss
0816T Opn insj/rplcmt ins ptn subq
0817T Opn insj/rplcmt ins ptn subf
61885 Insrt/redo neurostim 1 array
61891 Rev/rplcmt sk-mnt crnl nstm
63655 Implant neuroelectrodes
64580 Opn impltj nea neuromuscular
64590 Ins/rpl prph sac/gstr npg/r
|
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.
|
|
