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2026A Ambulatory Payment Classification: 5117
Title: Level 7 Musculoskeletal Procedures
| 2026A Relative Weight: | 303.2514 |
| 2026A Payment Rate: | $27721.73 |
| 2026A National Unadjusted Copay: | $ 0.00 |
| 2026A Minimum Unadjusted Copay: | $5544.35 |
Addendum D1 Information
Status Indicator: J1
Item / Code / Service:
Hospital Part B services paid through a comprehensive APC
OPPS Payment Status:
Paid under OPPS; all covered Part B services on the claim are packaged with the primary "J1" service for the claim, except services with OPPS SI=F,G, H, L and U; ambulance services; diagnostic and screening mammography; all preventive services; and certain Part B inpatient services.
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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:
0956T Prt crn ch cr&tun elt s-sclp
0960T Rpl s-sclp eltr ra rcvr&tlmt
20696 App mltpln uni xtrnl fix 1st
21243 Reconstruction of jaw joint
22558 Arthrd ant ntrbd min dsc lum
22630 Arthrd pst tq 1ntrspc lum
22633 Arthrd cmbn 1ntrspc lumbar
27702 Reconstruct ankle joint
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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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