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2025B Ambulatory Payment Classification: 5521
Title: Level 1 Imaging without Contrast
| 2025B Relative Weight: | 0.9874 |
| 2025B Payment Rate: | $ 88.05 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $ 17.61 |
Addendum D1 Information
Status Indicator: S
Item / Code / Service:
Procedure or Service, Not Discounted When Multiple
OPPS Payment Status:
Paid under OPPS; Separate APC payment.
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| 2021 Top 10 OPPS Facility Claims for APC 5521* |
| NPI | Organization | APC 5521 Submitted |
| 1679525919 |
THE CLEVELAND CLINIC FOUNDATION-CLEVELAND-OH
|
XX,XXX
|
| 1598703019 |
NEW YORK SOCIETY FOR THE RELIEF OF RUPTURED & CRIPPLED MAINTAINING-NEW YORK-NY
|
XX,XXX
|
| 1023049236 |
THE GENERAL HOSPITAL CORPORATION-SOMERVILLE-MA
|
XX,XXX
|
| 1649299827 |
BARNES JEWISH HOSPITAL-SAINT LOUIS-MO
|
XX,XXX
|
| 1184670549 |
NORTHSHORE UNIVERSITY HEALTHSYSTEM-EVANSTON-IL
|
XX,XXX
|
| 1518951300 |
HOAG MEMORIAL HOSPITAL PRESBYTERIAN-NEWPORT BEACH-CA
|
XX,XXX
|
| 1245294826 |
SARASOTA COUNTY PUBLIC HOSPITAL DISTRICT-SARASOTA-FL
|
XX,XXX
|
| 1164400131 |
LEHIGH VALLEY HOSPITAL-ALLENTOWN-PA
|
XX,XXX
|
| 1790717650 |
BRIGHAM & WOMENS HOSPITAL, INC.-SOMERVILLE-MA
|
XX,XXX
|
| 1699874248 |
SHANDS TEACHING HOSPITAL AND CLINICS, INC.-GAINESVILLE-FL
|
XX,XXX
|
* Medicare Part A utilization data is derived from the 100% 2021 Outpatient (Fee-for-Service) Standard Analytical File.
Procedure Codes in this APC:
0350T Rsa lower extr exam
0422T Tactile breast img uni/bi
0558T Ct scan f/biomchn ct alys
0689T Quan us tis charac w/o dx us
0712T N-nvs artl plaq alys quan
70030 X-ray eye for foreign body
70100 X-ray exam of jaw <4views
70140 X-ray exam of facial bones
70160 X-ray exam of nasal bones
70190 X-ray exam of eye sockets
70210 X-ray exam of sinuses
70220 X-ray exam of sinuses
70240 X-ray exam pituitary saddle
70300 X-ray exam of teeth
70328 X-ray exam of jaw joint
70330 X-ray exam of jaw joints
70350 X-ray head for orthodontia
70355 Panoramic x-ray of jaws
70360 X-ray exam of neck
70370 Throat x-ray & fluoroscopy
70380 X-ray exam of salivary gland
71045 X-ray exam chest 1 view
71046 X-ray exam chest 2 views
71047 X-ray exam chest 3 views
71100 X-ray exam ribs uni 2 views
71120 X-ray exam breastbone 2/>vws
71130 X-ray strenoclavic jt 3/>vws
72020 X-ray exam of spine 1 view
72040 X-ray exam neck spine 2-3 vw
72080 X-ray exam thoracolmb 2/> vw
72081 X-ray exam entire spi 1 vw
72220 X-ray exam sacrum tailbone
73000 X-ray exam of collar bone
73020 X-ray exam of shoulder
73030 X-ray exam of shoulder
73050 X-ray exam of shoulders
73060 X-ray exam of humerus
73070 X-ray exam of elbow
73080 X-ray exam of elbow
73090 X-ray exam of forearm
73100 X-ray exam of wrist
73110 X-ray exam of wrist
73130 X-ray exam of hand
73140 X-ray exam of finger(s)
73501 X-ray exam hip uni 1 view
73502 X-ray exam hip uni 2-3 views
73551 X-ray exam of femur 1
73552 X-ray exam of femur 2/>
73560 X-ray exam of knee 1 or 2
73562 X-ray exam of knee 3
73565 X-ray exam of knees
73590 X-ray exam of lower leg
73592 X-ray exam of leg infant
73600 X-ray exam of ankle
73610 X-ray exam of ankle
73620 X-ray exam of foot
73630 X-ray exam of foot
73650 X-ray exam of heel
73660 X-ray exam of toe(s)
74018 Radex abdomen 1 view
75571 Ct hrt w/o dye w/ca test
76010 X-ray nose to rectum
76016 Mr safety deter phys/qhp
76380 Cat scan follow-up study
76390 Mr spectroscopy
76496 Unlisted fluoroscopic px
76497 Unlisted ct procedure
76498 Unlisted mr procedure
76499 Unlisted dx radiographic px
76529 Echo exam of eye
76642 Ultrasound breast limited
76885 Us exam infant hips dynamic
76886 Us exam infant hips static
76999 Echo examination procedure
77071 Mnl appl strs jt radiography
77078 Ct bone density axial
77081 Dxa bone density appendiculr
77086 Vrt fracture assmt via dxa
77090 Tbs techl prep&transmis data
77091 Tbs techl calculation only
D0220 Intraoral periapical first
D0240 Intraoral occlusal film
D0250 Extraoral 2d project image
D0251 Extraoral posterior image
D0270 Dental bitewing single image
D0272 Dental bitewings two images
D0321 Other tmj images by report
D0340 2d cephalometric image
D0350 Oral/facial photo images
D0371 Sialoendoscopy capt & interp
D0393 Trtmnt simulation 3d image
D0394 Digital sub 2 or more images
D0395 Fusion 2 or more 3d images
D0701 Pano radio image
D0702 2d cephal radio image
D0703 2d oral/facial photo image
D0705 Extra oral post radio image
D0706 Intraoral occlus radio image
D0707 Intraoral periap radio image
D0708 Intraoral bite radio image
D0709 Intraoral comp image capture
G0183 Software meas of cardiac vol
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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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