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2025B Ambulatory Payment Classification: 9120
Title: Injection, Fulvestrant
| 2025B Relative Weight: | 0 |
| 2025B Payment Rate: | $ 6.90 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $ 1.38 |
Addendum D1 Information
Status Indicator: K
Item / Code / Service:
(1) Non-Pass-Through Drugs and Biologicals
(2) Therapeutic Radiopharmaceuticals
(3) Brachytherapy Sources
(4) Blood and Blood Products
OPPS Payment Status:
(1) Paid under OPPS; Separate APC payment.
(2) Paid under OPPS; Separate APC payment.
(3) Paid under OPPS; Separate APC payment.
(4) Paid under OPPS; Separate APC payment.
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| 2021 Top 10 OPPS Facility Claims for APC 9120* |
| NPI | Organization | APC 9120 Submitted |
| 1700887411 |
MEMORIAL HOSPITAL FOR CANCER AND ALLIED DISEASES-NEW YORK-NY
|
X,XXX
|
| 1851333686 |
DANA-FARBER CANCER INSTITUTE, INC.-BOSTON-MA
|
X,XXX
|
| 1457396079 |
NORTHSIDE HOSPITAL, INC.-ATLANTA-GA
|
XXX
|
| 1750358297 |
CITY OF HOPE NATIONAL MEDICAL CENTER-DUARTE-CA
|
XXX
|
| 1023049236 |
THE GENERAL HOSPITAL CORPORATION-SOMERVILLE-MA
|
XXX
|
| 1174582050 |
UNIVERSITY OF TEXAS M. D. ANDERSON CANCER CENTER-HOUSTON-TX
|
XXX
|
| 1952311508 |
UPMC MAGEE-WOMENS HOSPITAL-PITTSBURGH-PA
|
XXX
|
| 1780653618 |
H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE HOSPITAL, INC.-TAMPA-FL
|
XXX
|
| 1578778726 |
YALE NEW HAVEN HOSPITAL-NEW HAVEN-CT
|
XXX
|
| 1649259656 |
UNIVERSITY OF KANSAS HOSPITAL AUTHORITY-WESTWOOD-KS
|
XXX
|
* Medicare Part A utilization data is derived from the 100% 2021 Outpatient (Fee-for-Service) Standard Analytical File.
Procedure Codes in this APC:
J9395 Injection, fulvestrant
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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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