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2025B Ambulatory Payment Classification: 5821
Title: Level 1 Health and Behavior Services
| 2025B Relative Weight: | 0.3341 |
| 2025B Payment Rate: | $ 29.79 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $ 5.96 |
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 5821 * |
| NPI | Organization | APC 5821 Submitted |
| 1073606901 |
MEMORIAL HOSPITAL AT GULFPORT-GULFPORT-MS
|
XX,XXX
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| 1710909585 |
MISSISSIPPI BAPTIST MEDICAL CENTER, INC.-MEMPHIS-TN
|
X,XXX
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| 1295765261 |
BERKSHIRE MEDICAL CENTER, INC-PITTSFIELD-MA
|
X,XXX
|
| 1558392563 |
LAHEY CLINIC HOSPITAL, INC.-BURLINGTON-MA
|
X,XXX
|
| 1295761963 |
KNOX COMMUNITY HOSPITAL-MOUNT VERNON-OH
|
X,XXX
|
| 1427075027 |
FLETCHER HOSPITAL INC.-ATLANTA-GA
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X,XXX
|
| 1992738959 |
FISHER-TITUS MEDICAL CENTER-NORWALK-OH
|
XXX
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| 1376512988 |
INDIAN RIVER MEMORIAL HOSPITAL INC-VERO BEACH-FL
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XXX
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| 1194706655 |
YUMA REGIONAL MEDICAL CENTER-YUMA-AZ
|
XXX
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| 1477516466 |
SCOTT & WHITE MEMORIAL HOSPITAL-DALLAS-TX
|
XXX
|
* Medicare Part A utilization data is derived from the 100% 2021 Outpatient (Fee-for-Service) Standard Analytical File.
Procedure Codes in this APC:
0362T Bhv id suprt assmt ea 15 min
0373T Adapt bhv tx ea 15 min
90899 Unlisted psyc svc/therapy
96160 Pt-focused hlth risk assmt
96161 Caregiver health risk assmt
96164 Hlth bhv ivntj grp 1st 30
96167 Hlth bhv ivntj fam 1st 30
97154 Grp adapt bhv tx by tech
97156 Fam adapt bhv tx gdn phy/qhp
97157 Mult fam adapt bhv tx gdn
97158 Grp adapt bhv tx by phy/qhp
99406 Behav chng smoking 3-10 min
99407 Behav chng smoking > 10 min
99484 Care mgmt svc bhvl hlth cond
C7900 Hopd mntl hlt, 15-29 min
C7903 Hopd mntl hlt, grp
G0013 Hiv prep counsel, clin staff
G0136 Adm of soc dtr assess 5-15 m
G0323 Care manage beh svs 20mins
G0396 Alcohol/subs interv 15-30mn
G0442 Annual alcohol screen 15 min
G0444 Depression screen annual
G0446 Intens behave ther cardio dx
G0473 Group behave couns 2-10
G0537 Risk ascvd tst once pr 12 mo
G0556 Adv prim care mgmt lvl 1
G0557 Adv prim care mgmt lvl 2
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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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