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Oregon Health Authority Division of Medical Assistance Programs Addendum a - Final OPPS Apcs for CY 2012 Effective October 1, 2012

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Oregon Health Authority Division of Medical Assistance Programs Addendum A - Final OPPS APCs for CY 2012 Effective October 1, 2012 Relative APC Group Title SI Weight 0001 Level I Photochemotherapy S 0.5042 0002 Fine Needle Biopsy/Aspiration T 1.6115 0003 Bone Marrow Biopsy/Aspiration T 3.5702 0004 Level I Needle Biopsy/ Aspiration Except Bone Marrow T 4.5746 0005 Level II Needle Biopsy/Aspiration Except Bone Marrow T 8.1566 0006 Level I Incision & Drainage T 1.4206 0007 Level II Incision & Drainage T 13.1250 0008 Level III Incision and Drainage T 20.5648 0012 Level I Debridement & Destruction T 0.3878 0013 Level II Debridement & Destruction T 0.8785 0015 Level III Debridement & Destruction T 1.4989 0016 Level IV Debridement & Destruction T 2.7592 0017 Level V Debridement & Destruction T 21.6661 0019 Level I Excision/ Biopsy T 4.4238 0020 Level II Excision/ Biopsy T 8.2746 0021 Level III Excision/ Biopsy T 17.0074 0022 Level IV Excision/ Biopsy T 23.2662 0028 Level I Breast Surgery T 25.5054 0029 Level II Breast Surgery T 33.4070 0030 Level III Breast Surgery T 44.8999 0031 Smoking Cessation Services X 0.2997 0034 Mental Health Services Composite S 2.7295 0035 Vascular Puncture and Minor Diagnostic Procedures X 0.2691 0037 Level IV Needle Biopsy/Aspiration Except Bone Marrow T 15.3499 0039 Level I Implantation of Neurostimulator Generator S 216.7598 0040 Level I Implantation/Revision/Replacement of Neurostimulator Electrodes S 63.7616 0041 Level I Arthroscopy T 29.6568 0042 Level II Arthroscopy T 57.0137 0045 Bone/Joint Manipulation Under Anesthesia T 15.4592 0047 Arthroplasty without Prosthesis T 41.2275 0048 Level I Arthroplasty or Implantation with Prosthesis T 60.6542 0049 Level I Musculoskeletal Procedures Except Hand and Foot T 22.0777 0050 Level II Musculoskeletal Procedures Except Hand and Foot T 32.4068 0051 Level III Musculoskeletal Procedures Except Hand and Foot T 47.4682 0052 Level IV Musculoskeletal Procedures Except Hand and Foot T 88.7314 0053 Level I Hand Musculoskeletal Procedures T 17.1918 0054 Level II Hand Musculoskeletal Procedures T 28.8534 0055 Level I Foot Musculoskeletal Procedures T 22.1041 0056 Level II Foot Musculoskeletal Procedures T 58.3595 0057 Bunion Procedures T 32.7118 0058 Level I Strapping and Cast Application S 1.1276 0060 Manipulation Therapy S 0.3587 0061 Level II Implantation/Revision/Replacement of Neurostimulator Electrodes S 88.8062 0062 Level I Treatment Fracture/Dislocation T 26.1699 0063 Level II Treatment Fracture/Dislocation T 49.9153 0064 Level III Treatment Fracture/Dislocation T 68.1442 0065 Level I Stereotactic Radiosurgery, MRgFUS, and MEG S 12.8879 0066 Level II Stereotactic Radiosurgery, MRgFUS, and MEG S 35.9898 0067 Level III Stereotactic Radiosurgery, MRgFUS, and MEG S 48.1747 0069 Thoracoscopy T 34.4761 Page 1 of 18 Last updated 1/17/2013 Oregon Health Authority Division of Medical Assistance Programs Addendum A - Final OPPS APCs for CY 2012 Effective October 1, 2012 Relative APC Group Title SI Weight 0070 Thoracentesis/Lavage Procedures T 5.5079 0071 Level I Endoscopy Upper Airway T 1.0751 0072 Level II Endoscopy Upper Airway T 1.8640 0073 Level III Endoscopy Upper Airway T 4.4183 0074 Level IV Endoscopy Upper Airway T 21.3453 0075 Level V Endoscopy Upper Airway T 30.4202 0076 Level I Endoscopy Lower Airway T 10.4721 0077 Level I Pulmonary Treatment S 0.4248 0078 Level III Pulmonary Treatment S 1.4123 0079 Ventilation Initiation and Management S 3.0710 0080 Diagnostic Cardiac Catheterization T 38.8595 0082 Coronary or Non-Coronary Atherectomy T 105.1880 0083 Coronary Angioplasty, Valvuloplasty, and Level I Endovascular Revascularization of the Lower Extremity T 66.0408 0084 Level I Electrophysiologic Procedures S 9.9253 0085 Level II Electrophysiologic Procedures T 53.7347 0086 Level III Electrophysiologic Procedures T 128.2375 0088 Thrombectomy T 41.0473 0089 Insertion/Replacement of Permanent Pacemaker and Electrodes T 111.8799 0090 Level I Insertion/Replacement of Permanent Pacemaker T 94.2889 0091 Level II Vascular Ligation T 44.2193 0092 Level I Vascular Ligation T 26.8758 0093 Vascular Reconstruction/Fistula Repair without Device T 30.8203 0094 Level I Resuscitation and Cardioversion S 2.2313 0095 Cardiac Rehabilitation S 0.9950 0096 Level II Noninvasive Physiologic Studies S 1.5246 0097 Level I Noninvasive Physiologic Studies S 0.9348 0099 Electrocardiograms/Cardiography S 0.3823 0100 Cardiac Stress Tests X 2.5475 0101 Tilt Table Evaluation S 4.2654 0102 Level II Pulmonary Treatment S 0.5344 0103 Miscellaneous Vascular Procedures T 16.4097 0104 Transcatheter Placement of Intracoronary Stents T 81.3305 0105 Repair/Revision/Removal of Pacemakers, AICDs, or Vascular Devices T 22.7903 0106 Insertion/Replacement of Pacemaker Leads and/or Electrodes T 49.6518 0107 Insertion of Cardioverter-Defibrillator Pulse Generator T 346.9174 0108 Insertion/Replacement/Repair of AICD Leads, Generator, and Pacing Electrodes T 425.1499 0110 Transfusion S 3.4289 0111 Blood Product Exchange S 11.6555 0112 Apheresis and Stem Cell Procedures S 32.6165 0113 Excision Lymphatic System T 25.2698 0114 Thyroid/Lymphadenectomy Procedures T 51.3780 0115 Cannula/Access Device Procedures T 37.3584 0121 Level I Tube or Catheter Changes or Repositioning T 6.2131 0126 Level I Urinary and Anal Procedures T 1.1092 0127 Level IV Stereotactic Radiosurgery, MRgFUS, and MEG S 106.5264 0128 Echocardiogram with Contrast S 7.9579 0129 Level I Closed Treatment Fracture T 1.5023 0130 Level I Laparoscopy T 38.8880 0131 Level II Laparoscopy T 48.0079 0132 Level III Laparoscopy T 71.5531 Page 2 of 18 Last updated 1/17/2013 Oregon Health Authority Division of Medical Assistance Programs Addendum A - Final OPPS APCs for CY 2012 Effective October 1, 2012 Relative APC Group Title SI Weight 0133 Level I Skin Repair T 1.1944 0134 Level II Skin Repair T 3.2563 0135 Level III Skin Repair T 4.9694 0136 Level IV Skin Repair T 16.7455 0137 Level V Skin Repair T 21.3314 0138 Level II Closed Treatment Fracture T 5.0918 0139 Level III Closed Treatment Fracture T 19.1606 0140 Esophageal Dilation without Endoscopy T 6.5842 0141 Level I Upper GI Procedures T 8.4514 0142 Level I Small Intestine Endoscopy T 10.3443 0143 Lower GI Endoscopy T 9.3677 0146 Level I Sigmoidoscopy and Anoscopy T 6.2297 0147 Level II Sigmoidoscopy and Anoscopy T 11.0754 0148 Level I Anal/Rectal Procedures T 5.5610 0149 Level III Anal/Rectal Procedures T 24.4054 0150 Level IV Anal/Rectal Procedures T 32.9746 0151 Endoscopic Retrograde Cholangio-Pancreatography (ERCP) T 24.7014 0152 Level I Percutaneous Abdominal and Biliary Procedures T 29.1698 0153 Peritoneal and Abdominal Procedures T 27.4109 0154 Hernia/Hydrocele Procedures T 32.9296 0155 Level II Anal/Rectal Procedures T 15.4662 0156 Level III Urinary and Anal Procedures T 3.1880 0157 Colorectal Cancer Screening: Barium Enema S 2.7505 0158 Colorectal Cancer Screening: Colonoscopy T 8.3099 0159 Colorectal Cancer Screening: Flexible Sigmoidoscopy S 5.4078 0160 Level I Cystourethroscopy and other Genitourinary Procedures T 6.7724 0161 Level II Cystourethroscopy and other Genitourinary Procedures T 17.4928 0162 Level III Cystourethroscopy and other Genitourinary Procedures T 26.2784 0163 Level IV Cystourethroscopy and other Genitourinary Procedures T 37.0430 0164 Level II Urinary and Anal Procedures T 1.9495 0165 Level IV Urinary and Anal Procedures T 20.4458 0166 Level I Urethral Procedures T 20.9473 0168 Level II Urethral Procedures T 32.3095 0169 Lithotripsy T 41.2299 0170 Dialysis S 6.6871 0172 Level I Partial Hospitalization (3 services) for CMHCs P 1.3941 0173 Level II Partial Hospitalization (4 or more services) for CMHCs P 1.6252 0174 Level IV Laparoscopy T 109.7169 0175 Level I Partial Hospitalization (3 services) for Hospital-based PHPs P 2.2950 0176 Level II Partial Hospitalization (4 or more services) for Hospital-based PHPs P 2.7295 0181 Level II Male Genital Procedures T 34.6230 0183 Level I Male Genital Procedures T 23.5985 0184 Prostate Biopsy T 13.8400 0188 Level II Female Reproductive Proc T 1.5839 0189 Level III Female Reproductive Proc T 3.4852 0190 Level I Hysteroscopy T 23.0056 0191 Level I Female Reproductive Proc T 0.1309 0192 Level IV Female Reproductive Proc T 6.7568 0193 Level V Female Reproductive Proc T 20.6451 0195 Level VI Female Reproductive Procedures T 36.0353 Page 3 of 18 Last updated 1/17/2013 Oregon Health Authority Division of Medical Assistance Programs Addendum A - Final OPPS APCs for CY 2012 Effective October 1, 2012 Relative APC Group Title SI Weight 0202 Level VII Female Reproductive Procedures T 46.0040 0203 Level IV Nerve Injections T 12.8988 0204 Level I Nerve Injections T 2.6121 0206 Level II Nerve Injections T 3.8988 0207 Level III Nerve Injections T 7.4744 0208 Laminotomies and Laminectomies T 50.8933 0209 Level II Extended EEG, Sleep, and Cardiovascular Studies S 11.3584 0213 Level I Extended EEG, Sleep, and Cardiovascular Studies S 2.4311 0215 Level I Nerve and Muscle Tests S 0.6313 0216 Level III Nerve and Muscle Tests S 2.6461 0218 Level II Nerve and Muscle Tests S 1.2024 0220 Level I Nerve Procedures T 18.8841 0221 Level II Nerve Procedures T 36.0414 0224 Implantation of Catheter/Reservoir/Shunt T 41.6996 0227 Implantation of Drug Infusion Device T 193.0257 0229 Level II Endovascular Revascularization of the Lower Extremity T 115.6270 0230 Level I Eye Tests & Treatments S 0.6423 0231 Level III Eye Tests & Treatments S 2.0291 0232 Level I Anterior Segment Eye Procedures T 2.8709 0233 Level III Anterior Segment Eye Procedures T 16.6052 0234 Level
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    Supplemental online content for: Prevalence and Safety of Off-Label Use of Chemotherapeutic Agents in Older Patients With Breast Cancer: Estimates From SEER-Medicare Data Anne A. Eaton, MS; Camelia S. Sima, MD, MS; and Katherine S. Panageas, DrPH J Natl Compr Canc Netw 2016;14(1):57–65 • eAppendix 1: J-Codes Representing Intravenous Chemotherapy • eAppendix 2: Established Sequential Adjuvant Chemotherapy Regimens for Breast Cancer • eTable 1: Patient Characteristics © JNCCN—Journal of the National Comprehensive Cancer Network | Volume 14 Number 1 | January 2016 Eaton et al - 1 eAppendix 1: J-Codes Representing Intravenous Chemotherapy J-Code Agent J-Code Agent J9000 Injection, doxorubicin HCl, 10 mg J9165 Injection, diethylstilbestrol diphosphate, 250 J9001 Injection, doxorubicin HCl, all lipid mg formulations, 10 mg J9170 Injection, docetaxel, 20 mg J9010 Injection, alemtuzumab, 10 mg J9171 Injection, docetaxel, 1 mg J9015 Injection, aldesleukin, per single use vial J9175 Injection, Elliotts’ B solution, 1 ml J9017 Injection, arsenic trioxide, 1 mg J9178 Injection, epirubicin HCl, 2 mg J9020 Injection, asparaginase, 10,000 units J9179 Injection, eribulin mesylate, 0.1 mg J9025 Injection, azacitidine, 1 mg J9180 Epirubicin HCl, 50 mg J9027 Injection, clofarabine, 1 mg J9181 Injection, etoposide, 10 mg J9031 BCG (intravesical) per instillation J9182 Etoposide, 100 mg J9033 Injection, bendamustine HCl, 1 mg J9185 Injection, fludarabine phosphate, 50 mg J9035 Injection, bevacizumab, 10 mg J9190 Injection, fluorouracil, 500 mg J9040 Injection,