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2025B Ambulatory Payment Classification: 5301
Title: Level 1 Upper GI Procedures
| 2025B Relative Weight: | 10.5144 |
| 2025B Payment Rate: | $937.56 |
| 2025B National Unadjusted Copay: | $ 0.00 |
| 2025B Minimum Unadjusted Copay: | $187.52 |
Addendum D1 Information
Status Indicator: T
Item / Code / Service:
Procedure or Service, Multiple Procedure Reduction Applies
OPPS Payment Status:
Paid under OPPS; Separate APC payment.
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| 2021 Top 10 OPPS Facility Claims for APC 5301 * |
| NPI | Organization | APC 5301 Submitted |
| 1841266194 |
MAYO CLINIC HOSPITAL-ROCHESTER-ROCHESTER-MN
|
X,XXX
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| 1679525919 |
THE CLEVELAND CLINIC FOUNDATION-CLEVELAND-OH
|
X,XXX
|
| 1679578439 |
MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER-TYLER-TX
|
X,XXX
|
| 1891782470 |
MAYO CLINIC FLORIDA-JACKSONVILLE-FL
|
X,XXX
|
| 1306938071 |
ADVENTIST HEALTH SYSTEM-SUNBELT, INC-ALTAMONTE SPRINGS-FL
|
X,XXX
|
| 1023049236 |
THE GENERAL HOSPITAL CORPORATION-SOMERVILLE-MA
|
X,XXX
|
| 1003878539 |
REGENTS OF THE UNIVERSITY OF MICHIGAN-ANN ARBOR-MI
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X,XXX
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| 1801992631 |
NYU LANGONE HOSPITALS-NEW YORK-NY
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X,XXX
|
| 1396882205 |
VANDERBILT UNIVERSITY MEDICAL CENTER-NASHVILLE-TN
|
X,XXX
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| 1710918545 |
REGENTS OF THE UNIVERSITY OF CALIFORNIA-RANCHO CORDOVA-CA
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X,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:
0651T Mag ctrld capsule endoscopy
0813T Egd vol adjmt bariatric balo
40804 Removal foreign body mouth
43197 Esophagoscopy flex dx brush
43198 Esophagosc flex trnsn biopsy
43200 Esophagoscopy flexible brush
43235 Egd diagnostic brush wash
43236 Uppr gi scope w/submuc inj
43239 Egd biopsy single/multiple
43247 Egd remove foreign body
43248 Egd guide wire insertion
43291 Egd flx trnsorl rmvl balo
43450 Dilate esophagus 1/mult pass
43499 Unlisted procedure esophagus
43510 Surgical opening of stomach
43756 Dx duod intub w/asp spec
43757 Dx duod intub w/asp specs
43831 Gastrostomy open neonatal
43999 Unlisted procedure stomach
44100 Biopsy of bowel
44380 Small bowel endoscopy br/wa
44382 Small bowel endoscopy
44500 Intro gastrointestinal tube
44799 Unlisted px small intestine
47537 Removal biliary drg cath
47999 Unlisted px biliary tract
49082 Abd paracentesis
49083 Abd paracentesis w/imaging
49084 Peritoneal lavage
49450 Replace g/c tube perc
49451 Replace duod/jej tube perc
49452 Replace g-j tube perc
49460 Fix g/colon tube w/device
49999 Unlisted px abd pertm&omn
91110 Gi trc img intral esoph-ile
91111 Gi trc img intral esophagus
91112 Gi wireless capsule measure
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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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