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