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2025B Ambulatory Payment Classification: 5691
Title: Level 1 Drug Administration
| 2025B Relative Weight: | 0.5174 |
| 2025B Payment Rate: | $ 46.14 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $ 9.23 |
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 5691* |
| NPI | Organization | APC 5691 Submitted |
| 1700887411 |
MEMORIAL HOSPITAL FOR CANCER AND ALLIED DISEASES-NEW YORK-NY
|
XX,XXX
|
| 1679525919 |
THE CLEVELAND CLINIC FOUNDATION-CLEVELAND-OH
|
XX,XXX
|
| 1578778726 |
YALE NEW HAVEN HOSPITAL-NEW HAVEN-CT
|
XX,XXX
|
| 1174582050 |
UNIVERSITY OF TEXAS M. D. ANDERSON CANCER CENTER-HOUSTON-TX
|
XX,XXX
|
| 1134144801 |
HENRY FORD HEALTH SYSTEM-DETROIT-MI
|
XX,XXX
|
| 1871543215 |
STANFORD HEALTH CARE-STANFORD-CA
|
XX,XXX
|
| 1023049236 |
THE GENERAL HOSPITAL CORPORATION-SOMERVILLE-MA
|
XX,XXX
|
| 1851333686 |
DANA-FARBER CANCER INSTITUTE, INC.-BOSTON-MA
|
XX,XXX
|
| 1053384776 |
AHS HOSPITAL CORP.-MORRISTOWN-NJ
|
XX,XXX
|
| 1922043744 |
UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY-MIDDLETON-WI
|
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:
95115 Immunotherapy one injection
95117 Immunotherapy injections
95144 Antigen therapy services
95145 Antigen therapy services
95146 Antigen therapy services
95165 Antigen therapy services
95170 Antigen therapy services
96361 Hydrate iv infusion add-on
96366 Ther/proph/diag iv inf addon
96370 Sc ther infusion addl hr
96375 Tx/pro/dx inj new drug addon
96377 Applicaton on-body injector
96379 Unl ther/prop/diag inj/inf
96423 Chemo ia infuse each addl hr
96549 Unlisted chemotherapy px
G0008 Admin influenza virus vac
G0009 Admin pneumococcal vaccine
G0010 Admin hepatitis b vaccine
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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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