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2025B Ambulatory Payment Classification: 5822
Title: Level 2 Health and Behavior Services
| 2025B Relative Weight: | 1.0374 |
| 2025B Payment Rate: | $ 92.50 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $ 18.50 |
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 5822 * |
| NPI | Organization | APC 5822 Submitted |
| 1023119989 |
GENESIS BEHAVIORAL HOSPITAL INC-LAFAYETTE-LA
|
XX,XXX
|
| 1205809571 |
TURNING POINT CARE CENTER LLC-MOULTRIE-GA
|
XX,XXX
|
| 1477969970 |
BH-SD OPCO LLC-LA MESA-CA
|
XX,XXX
|
| 1811973100 |
OCHSNER CLINIC FOUNDATION-NEW ORLEANS-LA
|
XX,XXX
|
| 1346384468 |
SHARP MEMORIAL HOSPITAL-SAN DIEGO-CA
|
XX,XXX
|
| 1194758623 |
BHC ALHAMBRA HOSPITAL INC-ROSEMEAD-CA
|
XX,XXX
|
| 1285641514 |
LONG ISLAND JEWISH MEDICAL CENTER-WESTBURY-NY
|
XX,XXX
|
| 1750365375 |
DEANCO HEALTHCARE LLC-PANORAMA CITY-CA
|
XX,XXX
|
| 1356552806 |
PHYSICIANS BEHAVIORAL HOSPITAL, LLC-LAFAYETTE-LA
|
XX,XXX
|
| 1902988686 |
THE HARMONY CENTER INC-STERLINGTON-LA
|
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:
90853 Group psychotherapy
90880 Hypnotherapy
96156 Hlth bhv assmt/reassessment
97151 Bhv id assmt by phys/qhp
97152 Bhv id suprt assmt by 1 tech
97153 Adaptive behavior tx by tech
99426 Prin care mgmt staff 1st 30
99483 Assmt & care pln pt cog imp
99490 Chrnc care mgmt staff 1st 20
99492 1st psyc collab care mgmt
99493 Sbsq psyc collab care mgmt
99497 Advncd care plan 30 min
C7901 Hopd mntl hlt, 30-60 min
G0019 Comm hlth intg svs sdoh 60mn
G0023 Pin service 60m per month
G0101 Ca screen;pelvic/breast exam
G0140 Nav srv peer sup 60 min pr m
G0296 Visit to determ ldct elig
G0443 Brief alcohol misuse counsel
G0445 High inten beh couns std 30m
G0447 Behavior counsel obesity 15m
G0451 Devlopment test interpt&rep
G0538 Ascvd rsk mng clin stf pr mo
G0544 Post d/c phone follow up
G0558 Adv prim care mgmt lvl 3
G2214 Init/sub psych care m 1st 30
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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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