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2025B Ambulatory Payment Classification: 5823
Title: Level 3 Health and Behavior Services
| 2025B Relative Weight: | 1.8019 |
| 2025B Payment Rate: | $160.67 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $ 32.14 |
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 5823* |
| NPI | Organization | APC 5823 Submitted |
| 1023049236 |
THE GENERAL HOSPITAL CORPORATION-SOMERVILLE-MA
|
XX,XXX
|
| 1285641514 |
LONG ISLAND JEWISH MEDICAL CENTER-WESTBURY-NY
|
XX,XXX
|
| 1740389154 |
RICHMOND MEDICAL CENTER-STATEN ISLAND-NY
|
XX,XXX
|
| 1578627485 |
NYS OFFICE OF MENTAL HEALTH-ALBANY-NY
|
XX,XXX
|
| 1730246968 |
NYS OFFICE OF MENTAL HEALTH-ALBANY-NY
|
XX,XXX
|
| 1346285657 |
UNIVERSITY OF ROCHESTER-ROCHESTER-NY
|
X,XXX
|
| 1679883037 |
ST JOSEPHS HOSPITAL YONKERS-HARRISON-NY
|
X,XXX
|
| 1275697195 |
NYS OFFICE OF MENTAL HEALTH-ALBANY-NY
|
X,XXX
|
| 1952476988 |
MONTEFIORE MEDICAL CENTER-BRONX-NY
|
X,XXX
|
| 1114916954 |
CHRISTIAN HEALTH CARE CENTER-WYCKOFF-NJ
|
X,XXX
|
* Medicare Part A utilization data is derived from the 100% 2021 Outpatient (Fee-for-Service) Standard Analytical File.
Procedure Codes in this APC:
90791 Psych diagnostic evaluation
90792 Psych diag eval w/med srvcs
90832 Psytx w pt 30 minutes
90834 Psytx w pt 45 minutes
90837 Psytx w pt 60 minutes
90839 Psytx crisis initial 60 min
90845 Psychoanalysis
90846 Family psytx w/o pt 50 min
90847 Family psytx w/pt 50 min
90849 Multiple family group psytx
90865 Narcosynthesis
96158 Hlth bhv ivntj indiv 1st 30
97155 Adapt behavior tx phys/qhp
99487 Cplx chrnc care 1st 60 min
G0397 Alcohol/subs interv >30 min
G2086 Off base opioid tx 70min
G2087 Off base opioid tx, 60 m
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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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