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2025B Ambulatory Payment Classification: 9257
Title: Inj., emicizumab-kxwh 0.5 mg
| 2025B Relative Weight: | 0 |
| 2025B Payment Rate: | $ 51.98 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $ 10.40 |
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 9257* |
| NPI | Organization | APC 9257 Submitted |
| 1952332801 |
THE NEW YORK AND PRESBYTERIAN HOSPITAL-NEW YORK-NY
|
XX
|
| 1023092053 |
MARY HITCHCOCK MEMORIAL HOSPITAL-BOSTON-MA
|
XX
|
| 1588659528 |
RHODE ISLAND HOSPITAL-PROVIDENCE-RI
|
XX
|
| 1922043744 |
UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY-MIDDLETON-WI
|
XX
|
| 1932103413 |
MOUNT SINAI HOSPITAL-NEW YORK-NY
|
XX
|
| 1922090554 |
SPECTRUM HEALTH HOSPITALS-GRAND RAPIDS-MI
|
XX
|
| 1124028972 |
MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL-GAYLORD-MI
|
XX
|
| 1184709057 |
ORLANDO HEALTH, INC.-ORLANDO-FL
|
XX
|
* Medicare Part A utilization data is derived from the 100% 2021 Outpatient (Fee-for-Service) Standard Analytical File.
Procedure Codes in this APC:
J7170 Inj., emicizumab-kxwh 0.5 mg
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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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