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2025B Ambulatory Payment Classification: 5731
Title: Level 1 Minor Procedures
| 2025B Relative Weight: | 0.2747 |
| 2025B Payment Rate: | $ 24.49 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $ 4.90 |
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 5731* |
| NPI | Organization | APC 5731 Submitted |
| 1184639973 |
THE GRIFFIN HOSPITAL-DERBY-CT
|
XX,XXX
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| 1871543215 |
STANFORD HEALTH CARE-STANFORD-CA
|
XX,XXX
|
| 1578778726 |
YALE NEW HAVEN HOSPITAL-NEW HAVEN-CT
|
XX,XXX
|
| 1679525919 |
THE CLEVELAND CLINIC FOUNDATION-CLEVELAND-OH
|
XX,XXX
|
| 1922043744 |
UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY-MIDDLETON-WI
|
XX,XXX
|
| 1700887411 |
MEMORIAL HOSPITAL FOR CANCER AND ALLIED DISEASES-NEW YORK-NY
|
XX,XXX
|
| 1477516466 |
SCOTT & WHITE MEMORIAL HOSPITAL-DALLAS-TX
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XX,XXX
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| 1639172372 |
CEDARS-SINAI MEDICAL CENTER-LOS ANGELES-CA
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XX,XXX
|
| 1003878539 |
REGENTS OF THE UNIVERSITY OF MICHIGAN-ANN ARBOR-MI
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XX,XXX
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| 1497859649 |
NORTHWESTERN MEMORIAL HEALTHCARE-CHICAGO-IL
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XX,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:
0358T Bia whole body
0521T Interrog dev eval wcs ip
0555T B1 str&fx rsk transmis data
0631T Tc vis lit hyperspectral img
20560 Ndl insj w/o njx 1 or 2 musc
20561 Ndl insj w/o njx 3+ musc
20979 Us bone stimulation
76014 Mr sfty implt&/fb asmt stf 1
76514 Echo exam of eye thickness
86077 Phys blood bank serv xmatch
86485 Skin test candida
86486 Skin test unlisted antign ea
86580 Tb intradermal test
86976 Rbc serum pretx id dilution
86999 Unlisted transfusion med px
88106 Cytopath fl nongyn filter
88160 Cytopath smear other source
88161 Cytopath smear other source
88300 Surgical path gross
88363 Xm archive tissue molec anal
92499 Unlisted oph svc/procedure
92700 Unlisted orl service/px
93050 Art pressure waveform analys
93291 Interrog dev eval scrms ip
93998 Unlistd noninvas vasc dx std
95017 All tstg perq&iq w/venoms
95027 Iq tsts seql&incrl airborne
95199 Unlisted all/immlg svc/px
96146 Psycl/nrpsyc tst auto result
97810 Acup 1/> wo estim 1st 15 min
97813 Acup 1/> w/estim 1st 15 min
99473 Self-meas bp pt educaj/train
G0117 Glaucoma scrn hgh risk direc
G0237 Therapeutic procd strg endur
G0238 Oth resp proc, indiv
G0404 Ekg tracing for initial prev
G2011 Alcohol/sub misuse assess
Q0091 Obtaining screen pap smear
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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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