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2025B Ambulatory Payment Classification: 5492
Title: Level 2 Intraocular Procedures
| 2025B Relative Weight: | 45.115 |
| 2025B Payment Rate: | $4022.86 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $804.58 |
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 5492* |
| NPI | Organization | APC 5492 Submitted |
| 1639101751 |
MASSACHUSETTS EYE AND EAR INFIRMARY-BOSTON-MA
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X,XXX
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| 1881899284 |
CITY OF PHILA TRUSTEE ACTING BY THE BRD OF DIR OF CITY TRUSTS-PHILADELPHIA-PA
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X,XXX
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| 1578809430 |
UAB CALLAHAN EYE HOSPITAL AUTHORITY-BIRMINGHAM-AL
|
X,XXX
|
| 1043240682 |
BAPTIST HEALTH-LITTLE ROCK-AR
|
XXX
|
| 1760446256 |
ALLINA HEALTH SYSTEM-MINNEAPOLIS-MN
|
XXX
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| 1881647204 |
THE PRESBYTERIAN HOSPITAL-WINSTON-SALEM-NC
|
XXX
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| 1902803315 |
REGENTS UNIV OF CALIF LOS ANGELES-LOS ANGELES-CA
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XXX
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| 1245251222 |
NEW YORK EYE & EAR INFIRMARY-NEW YORK CITY-NY
|
XXX
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| 1679525919 |
THE CLEVELAND CLINIC FOUNDATION-CLEVELAND-OH
|
XXX
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| 1992703540 |
DUKE UNIVERSITY HEALTH SYSTEM, INC.-DURHAM-NC
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XXX
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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:
0253T Insert aqueous drain device
0621T Trabeculostomy interno laser
0660T Implt ant sgm io nbio rx sys
0661T Rmvl&rimpltj ant sgm implt
65730 Corneal transplant
65755 Corneal transplant
65756 Corneal trnspl endothelial
65785 Impltj ntrstrml crnl rng seg
65820 Goniotomy
65880 Incise inner eye adhesions
66150 Glaucoma surgery
66155 Glaucoma surgery
66174 Trluml dil aq o/f can w/o st
66183 Insert ant drainage device
66600 Remove iris and lesion
66852 Removal of lens material
66930 Extraction of lens
66987 Xcapsl ctrc rmvl cplx w/ecp
66988 Xcapsl ctrc rmvl w/ecp
67036 Removal of inner eye fluid
67039 Laser treatment of retina
67040 Laser treatment of retina
67041 Vit for macular pucker
67042 Vit for macular hole
67043 Vit for membrane dissect
67107 Repair detached retina
67108 Repair detached retina
67115 Release encircling material
67255 Reinforce/graft eye wall
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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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