| A | B | C | D | E | F | G | H | I | J | K | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Addendum B.- OPPS Payment by HCPCS Code for CY 2022 | CMS Zip file as "Correction" | ||||||||||
2 | CPT codes and descriptions only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Dental codes (D codes) are copyright 2021 American Dental Association. All Rights Reserved. | |||||||||||
3 | The existence or absence of a HCPCS code does not mean that an item or service is covered or non-covered. As a reminder, the fact that a drug, device, procedure, or service is assigned a HCPCS code and a payment rate under the OPPS does not imply coverage by the Medicare program, but indicates only how the product, procedure, or service may be paid if covered by the program. Medicare Administrative Contractors (MACs) determine whether a drug, device, procedure, or other service meets all program requirements for coverage. For example, MACs determine that it is reasonable and necessary to treat the beneficiary’s condition and whether it is excluded from payment. | |||||||||||
4 | HCPCS Code | Short Descriptor | SI | APC | Relative Weight | Payment Rate | National Unadjusted Copayment | Minimum Unadjusted Copayment | Note: Actual copayments would be lower due to the cap on copayments at the Inpatient Deductible of $1,556.00 | Drug Pass-Through Expiration during Calendar Year | * Indicates a Change | |
5 | 0001A | Adm sarscov2 30mcg/0.3ml 1st | S | 9397 | 0.4752 | $40.00 | $0.00 | $0.00 | ||||
6 | 0001F | Heart failure composite | E1 | |||||||||
7 | 0001U | Rbc dna hea 35 ag 11 bld grp | A | |||||||||
8 | 0002A | Adm sarscov2 30mcg/0.3ml 2nd | S | 9398 | 0.4752 | $40.00 | $0.00 | $0.00 | ||||
9 | 0002M | Liver dis 10 assays w/ash | Q4 | |||||||||
10 | 0002U | Onc clrct 3 ur metab alg plp | Q4 | |||||||||
11 | 0003A | Adm sarscov2 30mcg/0.3ml 3rd | S | 9398 | 0.4752 | $40.00 | $0.00 | $0.00 | ||||
12 | 0003M | Liver dis 10 assays w/nash | Q4 | |||||||||
13 | 0003U | Onc ovar 5 prtn ser alg scor | Q4 | |||||||||
14 | 0004A | Adm sarscov2 30mcg/0.3ml bst | S | 9398 | 0.4752 | $40.00 | $0.00 | $0.00 | ||||
15 | 0004M | Scoliosis dna alys | A | |||||||||
16 | 0005F | Osteoarthritis composite | E1 | |||||||||
17 | 0005U | Onco prst8 3 gene ur alg | Q4 | |||||||||
18 | 0006M | Onc hep gene risk classifier | A | |||||||||
19 | 0007M | Onc gastro 51 gene nomogram | A | |||||||||
20 | 0007U | Rx test prsmv ur w/def conf | Q4 | |||||||||
21 | 0008U | Hpylori detcj abx rstnc dna | A | |||||||||
22 | 0009U | Onc brst ca erbb2 amp/nonamp | Q4 | |||||||||
23 | 00100 | Anesth salivary gland | N | |||||||||
24 | 00102 | Anesth repair of cleft lip | N | |||||||||
25 | 00103 | Anesth blepharoplasty | N | |||||||||
26 | 00104 | Anesth electroshock | N | |||||||||
27 | 0010U | Nfct ds strn typ whl gen seq | Q4 | |||||||||
28 | 0011A | Adm sarscov2 100mcg/0.5ml1st | S | 9397 | 0.4752 | $40.00 | $0.00 | $0.00 | ||||
29 | 0011M | Onc prst8 ca mrna 12 gen alg | A | |||||||||
30 | 0011U | Rx mntr lc-ms/ms oral fluid | Q4 | |||||||||
31 | 00120 | Anesth ear surgery | N | |||||||||
32 | 00124 | Anesth ear exam | N | |||||||||
33 | 00126 | Anesth tympanotomy | N | |||||||||
34 | 0012A | Adm sarscov2 100mcg/0.5ml2nd | S | 9398 | 0.4752 | $40.00 | $0.00 | $0.00 | ||||
35 | 0012F | Cap bacterial assess | E1 | |||||||||
36 | 0012M | Onc mrna 5 gen rsk urthl ca | A | |||||||||
37 | 0013A | Adm sarscov2 100mcg/0.5ml3rd | S | 9398 | 0.4752 | $40.00 | $0.00 | $0.00 | ||||
38 | 0013M | Onc mrna 5 gen recr urthl ca | A | |||||||||
39 | 00140 | Anesth procedures on eye | N | |||||||||
40 | 00142 | Anesth lens surgery | N | |||||||||
41 | 00144 | Anesth corneal transplant | N | |||||||||
42 | 00145 | Anesth vitreoretinal surg | N | |||||||||
43 | 00147 | Anesth iridectomy | N | |||||||||
44 | 00148 | Anesth eye exam | N | |||||||||
45 | 0014A | Fee covid-19 vac 2 res | E1 | |||||||||
46 | 0014F | Comp preop assess cat surg | E1 | |||||||||
47 | 0014M | Liver ds alys 3 bmrk srm alg | Q4 | |||||||||
48 | 0015F | Melan follow-up complete | E1 | |||||||||
49 | 0015M | Adrnl cortcl tum bchm asy 25 | Q4 | |||||||||
50 | 00160 | Anesth nose/sinus surgery | N | |||||||||
51 | 00162 | Anesth nose/sinus surgery | N | |||||||||
52 | 00164 | Anesth biopsy of nose | N | |||||||||
53 | 0016M | Onc bladder mrna 219 gen alg | A | |||||||||
54 | 0016U | Onc hmtlmf neo rna bcr/abl1 | A | |||||||||
55 | 00170 | Anesth procedure on mouth | N | |||||||||
56 | 00172 | Anesth cleft palate repair | N | |||||||||
57 | 00174 | Anesth pharyngeal surgery | N | |||||||||
58 | 00176 | Anesth pharyngeal surgery | C | |||||||||
59 | 0017M | Onc dlbcl mrna 20 genes alg | A | |||||||||
60 | 0017U | Onc hmtlmf neo jak2 mut dna | A | |||||||||
61 | 0018M | Trnsplj rnl meas cd154+cll | Q4 | |||||||||
62 | 0018U | Onc thyr 10 microrna seq alg | A | |||||||||
63 | 00190 | Anesth face/skull bone surg | N | |||||||||
64 | 00192 | Anesth facial bone surgery | C | |||||||||
65 | 0019U | Onc rna tiss predict alg | A | |||||||||
66 | 00210 | Anesth cranial surg nos | N | |||||||||
67 | 00211 | Anesth cran surg hemotoma | C | |||||||||
68 | 00212 | Anesth skull drainage | N | |||||||||
69 | 00214 | Anesth skull drainage | C | |||||||||
70 | 00215 | Anesth skull repair/fract | C | |||||||||
71 | 00216 | Anesth head vessel surgery | N | |||||||||
72 | 00218 | Anesth special head surgery | N | |||||||||
73 | 0021A | Adm sarscov2 5x1010vp/.5ml 1 | E1 | |||||||||
74 | 0021U | Onc prst8 detcj 8 autoantb | Q4 | |||||||||
75 | 00220 | Anesth intrcrn nerve | N | |||||||||
76 | 00222 | Anesth head nerve surgery | N | |||||||||
77 | 0022A | Adm sarscov2 5x1010vp/.5ml 2 | E1 | |||||||||
78 | 0022U | Trgt gen seq dna&rna 1-23 gn | A | |||||||||
79 | 0023A | Fee covid-19 vac 3 booster | E1 | |||||||||
80 | 0023U | Onc aml dna detcj/nondetcj | A | |||||||||
81 | 0024A | Fee covid-19 vac 3 res | E1 | |||||||||
82 | 0024U | Glyca nuc mr spectrsc quan | Q4 | |||||||||
83 | 0025U | Tenofovir liq chrom ur quan | Q4 | |||||||||
84 | 0026U | Onc thyr dna&mrna 112 genes | A | |||||||||
85 | 0027U | Jak2 gene trgt seq alys | A | |||||||||
86 | 0029U | Rx metab advrs trgt seq alys | A | |||||||||
87 | 00300 | Anesth head/neck/ptrunk | N | |||||||||
88 | 0030U | Rx metab warf trgt seq alys | A | |||||||||
89 | 0031A | Adm sarscov2 vac ad26 .5ml | S | 9398 | 0.4752 | $40.00 | $0.00 | $0.00 | ||||
90 | 0031U | Cyp1a2 gene | A | |||||||||
91 | 00320 | Anesth neck organ 1yr/> | N | |||||||||
92 | 00322 | Anesth biopsy of thyroid | N | |||||||||
93 | 00326 | Anesth larynx/trach < 1 yr | N | |||||||||
94 | 0032A | Fee covid-19 vac 4 dose 2 | E1 | |||||||||
95 | 0032U | Comt gene | A | |||||||||
96 | 0033A | Fee covid-19 vac 4 booster | E1 | |||||||||
97 | 0033U | Htr2a htr2c genes | A | |||||||||
98 | 0034A | Adm sarscov2 vac ad26 .5ml b | S | 9398 | 0.4752 | $40.00 | $0.00 | |||||
99 | 0034U | Tpmt nudt15 genes | A | |||||||||
100 | 00350 | Anesth neck vessel surgery | N | |||||||||