APC Codes 2026: Full OPPS APC List with Rates

TL;DR

The October 2026 OPPS Addendum A lists 1,061 ambulatory payment classifications. 304 pay a procedure or service (73 comprehensive J1 APCs, 112 New Technology APCs and 119 others), and the remaining 757 pay drugs and biologicals, pass-through devices, non-opioid products for post-surgical pain relief, blood products and brachytherapy sources. Addendum B assigns 6,379 HCPCS and CPT codes to the clinical APCs, not counting dental D codes. Rates run from $22.06 for APC 5811 to $64,263.52 for APC 5244, each about $91.415 per unit of relative weight.

Addendum A in numbers

APCs in Addendum A: 1,061; 304 for procedures and services
Comprehensive (J1) APCs: 73; one payment for the whole claim
New Technology APCs: 112; cost bands for new services
Codes in clinical APCs: 6,379; 540 HCPCS Level II, the rest CPT; dental D codes not counted
Rate per unit of weight: $91.415; payment rate divided by relative weight
Copayment cap: $1,736.00; the 2026 inpatient deductible

How an APC payment is calculated

Each APC has a relative weight that compares its cost with every other APC. The national payment rate is the weight times the OPPS conversion factor; dividing each rate in the October file by its weight gives $91.415, with differences of a few tenths of a cent from rounding in the published weights. A hospital does not receive the national rate as printed: 60 percent of it, the labor-related share, is multiplied by the hospital's wage index and added back to the other 40 percent, and outlier, rural sole community hospital and other adjustments apply on top.

The beneficiary pays a copayment. Addendum A prints a minimum unadjusted copayment of 20 percent of the national rate for nearly every APC (the vaccine administration APCs 9398 and 9399 carry no copayment) and, where it is higher, a national unadjusted copayment; the copayment for a single service cannot exceed the inpatient hospital deductible, $1,736.00 in 2026, which caps 63 clinical APCs. For the hospitals to which the 340B remedy offset applies, CMS says the adjusted rates and copayments for most separately paid status indicators are the printed amounts times 0.9951. Status indicator T procedures are discounted when several are billed on one claim (the highest-paid at 100 percent, the others at 50 percent), while S procedures are paid in full; the status indicator reference explains every indicator and the packaging rules.

APC families

CMS has organized most procedure APCs into clinical families with numbered levels, so that clinically similar services of similar cost share a level of one family. The October 2026 file has 38 families with two or more levels, the widest being Urology and Related Services with 8, and single-APC groups such as critical care, hyperbaric oxygen and dialysis.

Clinical APC families in the October 2026 OPPS Addendum A
Family	APCs	Rates	Codes
Radiation tx delivery	4017, 4018, 4019	$79.49 to $391.46	—
Clinic Visits and Related Services	5012	$136.02	22
Type A ED Visits	5021, 5022, 5023, 5024, 5025	$86.15 to $608.43	8
Type B ED Visits	5031, 5032, 5033, 5034, 5035	$75.94 to $419.62	5
Critical Care	5041	$843.92	1
Trauma Response with Critical Care	5045	$1,361.78	1
Skin Procedures	5051, 5052, 5053, 5054, 5055	$204.98 to $3,620.48	286
Hyperbaric Oxygen	5061	$140.59	1
Excision/Biopsy/Incision and Drainage	5071, 5072, 5073	$723.47 to $2,967.63	262
Breast/Lymphatic Surgery and Related Procedures	5091, 5092, 5093, 5094	$4,000.24 to $14,079.44	47
Strapping and Cast Application	5101, 5102	$166.02 to $285.75	44
Musculoskeletal Procedures	5111, 5112, 5113, 5114, 5115, 5116, 5117	$252.01 to $27,721.73	1,295
Airway Endoscopy	5151, 5152, 5153, 5154, 5155	$203.93 to $7,210.32	87
ENT Procedures	5161, 5162, 5163, 5164, 5165	$241.98 to $6,048.05	507
Cochlear Implant Procedure	5166	$33,686.28	1
Vascular Procedures	5181, 5182, 5183, 5184	$640.89 to $5,685.01	199
Endovascular Procedures	5191, 5192, 5193, 5194	$3,312.15 to $18,728.69	110
Implantation Wireless PA Pressure Monitor	5200	$29,304.62	1
Electrophysiologic Procedures	5211, 5212, 5213	$1,243.91 to $26,703.99	19
Pacemaker and Similar Procedures	5221, 5222, 5223, 5224	$3,817.90 to $19,678.89	63
ICD and Similar Procedures	5231, 5232	$22,725.36 to $32,068.73	17
Blood Product Exchange and Related Services	5241, 5242, 5243, 5244	$450.73 to $64,263.52	34
Upper GI Procedures	5301, 5302, 5303	$926.63 to $3,938.98	124
Lower GI Procedures	5311, 5312, 5313	$950.10 to $2,835.78	140
Complex GI Procedures	5331	$6,202.39	17
Abdominal/Peritoneal/Biliary and Related Procedures	5341, 5342	$3,657.95 to $6,614.04	52
Laparoscopy and Related Services	5361, 5362	$6,176.47 to $10,860.07	141
Urology and Related Services	5371, 5372, 5373, 5374, 5375, 5376, 5377, 5378	$255.26 to $21,175.04	319
Dialysis	5401	$701.18	2
Gynecologic Procedures	5411, 5412, 5413, 5414, 5415, 5416	$206.55 to $7,576.05	168
Nerve Procedures	5431, 5432, 5433	$1,995.02 to $8,965.93	103
Nerve Injections	5441, 5442, 5443	$313.60 to $903.63	96
Neurostimulator and Related Procedures	5461, 5462, 5463, 5464, 5465	$3,571.83 to $31,526.06	61
Implantation of Drug Infusion Device	5471	$18,414.24	3
Laser Eye Procedures	5481	$561.91	15
Intraocular Procedures	5491, 5492, 5493, 5494, 5495, 5496	$2,357.81 to $16,817.36	106
Extraocular, Repair, and Plastic Eye Procedures	5501, 5502, 5503, 5504	$324.28 to $4,016.55	161
Imaging without Contrast	5521, 5522, 5523, 5524	$88.91 to $558.25	294
Imaging with Contrast	5571, 5572, 5573	$179.20 to $800.90	139
Nuclear Medicine and Related Services	5591, 5592, 5593, 5594	$408.43 to $1,460.92	121
Therapeutic Radiation Treatment Preparation	5611, 5612, 5613	$137.32 to $1,414.11	26
Radiation Therapy	5621, 5622, 5623, 5624, 5625, 5626, 5627	$104.24 to $7,524.82	34
Therapeutic Nuclear Medicine	5661	$238.39	8
Pathology	5671, 5672, 5673, 5674	$53.24 to $823.13	100
Drug Administration	5691, 5692, 5693, 5694	$47.84 to $337.46	60
Diagnostic Tests and Related Services	5721, 5722, 5723, 5724	$131.46 to $877.34	218
Minor Procedures	5731, 5732, 5733, 5734, 5735	$29.55 to $456.40	294
Electronic Analysis of Devices	5741, 5742, 5743	$38.13 to $313.79	78
Cardiac Rehabilitation	5771	$131.70	4
Resuscitation and Cardioversion	5781	$675.26	4
Pulmonary Treatment	5791	$223.72	7
Ventilation Initiation and Management	5801	$631.17	2
Manipulation Therapy	5811	$22.06	8
Health and Behavior Services	5821, 5822, 5823	$38.28 to $181.34	73
Intensive Outpatient (3 services) for CMHCs	5851	$127.74	—
Intensive Outpatient (4 or more services) for CMHCs	5852	$167.38	—
Partial Hospitalization (3 services) for CMHCs	5853	$127.74	—
Partial Hospitalization (4 or more services) for CMHCs	5854	$167.38	—
Intensive Outpatient (3 services) for Hospital-based IOPs	5861	$319.38	—
Intensive Outpatient (4 or more services) for Hospital-based IOPs	5862	$418.45	—
Partial Hospitalization (3 services) for Hospital-based PHPs	5863	$319.38	—
Partial Hospitalization (4 or more services) for Hospital-based PHPs	5864	$418.45	—
Dental Procedures	5871	$660.49	—
Ancillary Outpatient Services When Patient Dies	5881	$14,228.88	—
PMA Skin Substitute Products	6000	$127.14	7
510K Skin Substitute Products	6001	$127.14	70
HCT/P Skin Substitute Products	6002	$127.14	251
Ultrasound Composite	8004	$300.57	—
CT and CTA without Contrast Composite	8005	$226.07	—
CT and CTA with Contrast Composite	8006	$438.90	—
MRI and MRA without Contrast Composite	8007	$537.85	—
MRI and MRA with Contrast Composite	8008	$867.08	—
Mental Health Services Composite	8010	$418.45	—
Comprehensive Observation Services	8011	$2,672.15	—
Covid-19 Vaccine Administration	9398	$41.52	1
Pneumococcal, Influenza, Hepatitis B, and/or Covid-19 Vaccine Home Administration	9399	$36.85	1

Every clinical APC with its rate

192 APCs pay procedures, visits, imaging, tests, therapies and other services (New Technology APCs follow below). Codes counts the HCPCS and CPT codes October Addendum B assigns to the APC, as CPT / Level II, excluding dental D codes. 20 APCs show no codes (—). APC 5871 holds only dental D codes, which this reference does not list or count. The other 19 are assigned by the integrated outpatient code editor (I/OCE) rather than through the Addendum B code list: by claim-level logic for the composite, partial hospitalization and intensive outpatient per diem, comprehensive observation and similar APCs, or to codes that Addendum B does not list.

Clinical APCs in the October 2026 OPPS Addendum A with status indicator, weight, rate, copayment and code counts
APC	Group title	SI	Weight	Rate	Min. copay	Codes
4017	Radiation tx delivery lvl 1	S	0.8696	$79.49	$15.90	—
4018	Radiation tx delivery lvl 2	S	3.4747	$317.64	$63.53	—
4019	Radiation tx delivery lvl 3	S	4.2822	$391.46	$78.30	—
5012	Clinic Visits and Related Services	V	1.4879	$136.02	$27.21	14 / 8
5021	Level 1 Type A ED Visits	V	0.9424	$86.15	$17.23	1 / 0
5022	Level 2 Type A ED Visits	V	1.7160	$156.87	$31.38	1 / 0
5023	Level 3 Type A ED Visits	V	3.0508	$278.89	$55.78	1 / 0
5024	Level 4 Type A ED Visits	V	4.6634	$426.30	$85.26	2 / 1
5025	Level 5 Type A ED Visits	V	6.6557	$608.43	$121.69	1 / 1
5031	Level 1 Type B ED Visits	V	0.8307	$75.94	$15.19	0 / 1
5032	Level 2 Type B ED Visits	V	1.0381	$94.90	$18.98	0 / 1
5033	Level 3 Type B ED Visits	V	1.9210	$175.61	$35.13	0 / 1
5034	Level 4 Type B ED Visits	V	2.9539	$270.03	$54.01	0 / 1
5035	Level 5 Type B ED Visits	V	4.5903	$419.62	$83.93	0 / 1
5041	Critical Care	S	9.2318	$843.92	$168.79	1 / 0
5045	Trauma Response with Critical Care	S	14.8967	$1,361.78	$272.36	0 / 1
5051	Level 1 Skin Procedures	T	2.2423	$204.98	$41.00	63 / 1
5052	Level 2 Skin Procedures	T	4.5432	$415.32	$83.07	67 / 0
5053	Level 3 Skin Procedures	T	8.2599	$755.08	$151.02	34 / 0
5054	Level 4 Skin Procedures	T	23.0593	$2,107.97	$421.60	75 / 3
5055	Level 5 Skin Procedures	T	39.6049	$3,620.48	$724.10	43 / 0
5061	Hyperbaric Oxygen	S	1.5379	$140.59	$28.12	0 / 1
5071	Level 1 Excision/Biopsy/Incision and Drainage	T	7.9141	$723.47	$144.70	51 / 0
5072	Level 2 Excision/Biopsy/Incision and Drainage	J1	18.4584	$1,687.37	$337.48	94 / 0
5073	Level 3 Excision/Biopsy/Incision and Drainage	J1	32.4633	$2,967.63	$593.53	117 / 0
5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	J1	43.7591	$4,000.24	$800.05	27 / 0
5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	J1	74.2109	$6,783.99	$1,356.80	13 / 0
5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	J1	91.3463	$8,350.42	$1,670.09	5 / 0
5094	Level 4 Breast/Lymphatic Surgery and Related ProceduresCopayment capped at the inpatient deductible	J1	154.0167	$14,079.44	$2,815.89	2 / 0
5101	Level 1 Strapping and Cast Application	T	1.8161	$166.02	$33.21	16 / 0
5102	Level 2 Strapping and Cast Application	T	3.1259	$285.75	$57.15	28 / 0
5111	Level 1 Musculoskeletal Procedures	T	2.7568	$252.01	$50.41	103 / 0
5112	Level 2 Musculoskeletal Procedures	J1	17.9710	$1,642.82	$328.57	142 / 0
5113	Level 3 Musculoskeletal Procedures	J1	36.5681	$3,342.87	$668.58	445 / 1
5114	Level 4 Musculoskeletal Procedures	J1	81.0959	$7,413.38	$1,482.68	429 / 4
5115	Level 5 Musculoskeletal ProceduresCopayment capped at the inpatient deductible	J1	143.4859	$13,116.76	$2,623.36	114 / 3
5116	Level 6 Musculoskeletal ProceduresCopayment capped at the inpatient deductible	J1	195.9590	$17,913.59	$3,582.72	45 / 1
5117	Level 7 Musculoskeletal ProceduresCopayment capped at the inpatient deductible	J1	303.2514	$27,721.73	$5,544.35	8 / 0
5151	Level 1 Airway Endoscopy	T	2.2308	$203.93	$40.79	6 / 0
5152	Level 2 Airway Endoscopy	T	4.3712	$399.59	$79.92	8 / 0
5153	Level 3 Airway Endoscopy	J1	19.8922	$1,818.45	$363.69	21 / 0
5154	Level 4 Airway Endoscopy	J1	41.6682	$3,809.10	$761.82	25 / 0
5155	Level 5 Airway Endoscopy	J1	78.8746	$7,210.32	$1,442.07	27 / 0
5161	Level 1 ENT Procedures	T	2.6471	$241.98	$48.40	35 / 0
5162	Level 2 ENT Procedures	T	6.0276	$551.01	$110.21	28 / 0
5163	Level 3 ENT Procedures	J1	17.3406	$1,585.19	$317.04	54 / 1
5164	Level 4 ENT Procedures	J1	37.0538	$3,387.27	$677.46	120 / 1
5165	Level 5 ENT Procedures	J1	66.1604	$6,048.05	$1,209.61	268 / 0
5166	Cochlear Implant ProcedureCopayment capped at the inpatient deductible	J1	368.4984	$33,686.28	$6,737.26	1 / 0
5181	Level 1 Vascular Procedures	T	7.0108	$640.89	$128.18	22 / 0
5182	Level 2 Vascular Procedures	J1	17.5928	$1,608.25	$321.65	20 / 0
5183	Level 3 Vascular Procedures	J1	35.2882	$3,225.87	$645.18	98 / 0
5184	Level 4 Vascular Procedures	J1	62.1890	$5,685.01	$1,137.01	59 / 0
5191	Level 1 Endovascular Procedures	J1	36.2320	$3,312.15	$662.43	17 / 0
5192	Level 2 Endovascular Procedures	J1	63.6092	$5,814.84	$1,162.97	14 / 0
5193	Level 3 Endovascular ProceduresCopayment capped at the inpatient deductible	J1	129.0185	$11,794.23	$2,358.85	34 / 6
5194	Level 4 Endovascular ProceduresCopayment capped at the inpatient deductible	J1	204.8755	$18,728.69	$3,745.74	30 / 9
5200	Implantation Wireless PA Pressure MonitorCopayment capped at the inpatient deductible	J1	320.5669	$29,304.62	$5,860.93	1 / 0
5211	Level 1 Electrophysiologic Procedures	J1	13.6073	$1,243.91	$248.79	8 / 0
5212	Level 2 Electrophysiologic Procedures	J1	87.1695	$7,968.60	$1,593.72	8 / 0
5213	Level 3 Electrophysiologic ProceduresCopayment capped at the inpatient deductible	J1	292.1182	$26,703.99	$5,340.80	3 / 0
5221	Level 1 Pacemaker and Similar Procedures	T	41.7645	$3,817.90	$763.58	24 / 0
5222	Level 2 Pacemaker and Similar Procedures	J1	92.4862	$8,454.63	$1,690.93	16 / 0
5223	Level 3 Pacemaker and Similar ProceduresCopayment capped at the inpatient deductible	J1	116.8121	$10,678.38	$2,135.68	11 / 0
5224	Level 4 Pacemaker and Similar ProceduresCopayment capped at the inpatient deductible	J1	215.2698	$19,678.89	$3,935.78	12 / 0
5231	Level 1 ICD and Similar ProceduresCopayment capped at the inpatient deductible	J1	248.5955	$22,725.36	$4,545.08	10 / 0
5232	Level 2 ICD and Similar ProceduresCopayment capped at the inpatient deductible	J1	350.8038	$32,068.73	$6,413.75	7 / 0
5241	Level 1 Blood Product Exchange and Related Services	S	4.9306	$450.73	$90.15	17 / 0
5242	Level 2 Blood Product Exchange and Related Services	S	17.4059	$1,591.16	$318.24	9 / 0
5243	Level 3 Blood Product Exchange and Related Services	S	48.6774	$4,449.84	$889.97	7 / 0
5244	Level 4 Blood Product Exchange and Related ServicesCopayment capped at the inpatient deductible	J1	702.9866	$64,263.52	$12,852.71	1 / 0
5301	Level 1 Upper GI Procedures	T	10.1365	$926.63	$185.33	39 / 0
5302	Level 2 Upper GI Procedures	J1	21.4458	$1,960.47	$392.10	68 / 0
5303	Level 3 Upper GI Procedures	J1	43.0890	$3,938.98	$787.80	15 / 2
5311	Level 1 Lower GI Procedures	T	10.3933	$950.10	$190.02	25 / 5
5312	Level 2 Lower GI Procedures	T	13.3737	$1,222.56	$244.52	53 / 0
5313	Level 3 Lower GI Procedures	J1	31.0209	$2,835.78	$567.16	56 / 1
5331	Complex GI Procedures	J1	67.8487	$6,202.39	$1,240.48	17 / 0
5341	Level 1 Abdominal/Peritoneal/Biliary and Related Procedures	J1	40.0148	$3,657.95	$731.59	38 / 0
5342	Level 2 Abdominal/Peritoneal/Biliary and Related Procedures	J1	72.3518	$6,614.04	$1,322.81	13 / 1
5361	Level 1 Laparoscopy and Related Services	J1	67.5652	$6,176.47	$1,235.30	84 / 0
5362	Level 2 Laparoscopy and Related ServicesCopayment capped at the inpatient deductible	J1	118.7997	$10,860.07	$2,172.02	55 / 2
5371	Level 1 Urology and Related Services	T	2.7923	$255.26	$51.06	24 / 0
5372	Level 2 Urology and Related Services	J1	7.7930	$712.40	$142.48	18 / 0
5373	Level 3 Urology and Related Services	J1	23.3623	$2,135.66	$427.14	55 / 0
5374	Level 4 Urology and Related Services	J1	39.3954	$3,601.33	$720.27	124 / 0
5375	Level 5 Urology and Related Services	J1	59.9237	$5,477.93	$1,095.59	59 / 2
5376	Level 6 Urology and Related ServicesCopayment capped at the inpatient deductible	J1	105.7977	$9,671.50	$1,934.30	21 / 2
5377	Level 7 Urology and Related ServicesCopayment capped at the inpatient deductible	J1	147.4509	$13,479.22	$2,695.85	5 / 0
5378	Level 8 Urology and Related ServicesCopayment capped at the inpatient deductible	J1	231.6364	$21,175.04	$4,235.01	9 / 0
5401	Dialysis	S	7.6703	$701.18	$140.24	1 / 1
5411	Level 1 Gynecologic Procedures	T	2.2595	$206.55	$41.31	16 / 0
5412	Level 2 Gynecologic Procedures	T	3.4057	$311.33	$62.27	21 / 0
5413	Level 3 Gynecologic Procedures	T	10.2937	$941.00	$188.20	10 / 0
5414	Level 4 Gynecologic Procedures	J1	36.1783	$3,307.24	$661.45	68 / 0
5415	Level 5 Gynecologic Procedures	J1	55.9077	$5,110.80	$1,022.16	41 / 1
5416	Level 6 Gynecologic Procedures	J1	82.8754	$7,576.05	$1,515.21	11 / 0
5431	Level 1 Nerve Procedures	J1	21.8238	$1,995.02	$399.01	62 / 0
5432	Level 2 Nerve Procedures	J1	38.1791	$3,490.14	$698.03	16 / 2
5433	Level 3 Nerve ProceduresCopayment capped at the inpatient deductible	J1	98.0794	$8,965.93	$1,793.19	23 / 0
5441	Level 1 Nerve Injections	T	3.4305	$313.60	$62.72	29 / 0
5442	Level 2 Nerve Injections	T	7.8890	$721.17	$144.24	29 / 1
5443	Level 3 Nerve Injections	T	9.8849	$903.63	$180.73	37 / 0
5461	Level 1 Neurostimulator and Related Procedures	J1	39.0727	$3,571.83	$714.37	22 / 0
5462	Level 2 Neurostimulator and Related Procedures	J1	71.2250	$6,511.03	$1,302.21	6 / 0
5463	Level 3 Neurostimulator and Related ProceduresCopayment capped at the inpatient deductible	J1	124.5314	$11,384.04	$2,276.81	13 / 2
5464	Level 4 Neurostimulator and Related ProceduresCopayment capped at the inpatient deductible	J1	216.8168	$19,820.31	$3,964.07	6 / 0
5465	Level 5 Neurostimulator and Related ProceduresCopayment capped at the inpatient deductible	J1	344.8675	$31,526.06	$6,305.22	10 / 2
5471	Implantation of Drug Infusion DeviceCopayment capped at the inpatient deductible	J1	201.4356	$18,414.24	$3,682.85	3 / 0
5481	Laser Eye Procedures	T	6.1468	$561.91	$112.39	14 / 1
5491	Level 1 Intraocular Procedures	J1	25.7924	$2,357.81	$471.57	56 / 0
5492	Level 2 Intraocular Procedures	J1	46.1954	$4,222.95	$844.59	31 / 0
5493	Level 3 Intraocular Procedures	J1	59.4712	$5,436.56	$1,087.32	15 / 0
5494	Level 4 Intraocular ProceduresCopayment capped at the inpatient deductible	J1	162.1211	$14,820.30	$2,964.06	1 / 0
5495	Level 5 Intraocular ProceduresCopayment capped at the inpatient deductible	J1	155.9391	$14,255.17	$2,851.04	1 / 0
5496	Level 6 Intraocular ProceduresCopayment capped at the inpatient deductible	J1	183.9672	$16,817.36	$3,363.48	2 / 0
5501	Level 1 Extraocular, Repair, and Plastic Eye Procedures	T	3.5473	$324.28	$64.86	26 / 0
5502	Level 2 Extraocular, Repair, and Plastic Eye Procedures	T	11.1412	$1,018.47	$203.70	12 / 0
5503	Level 3 Extraocular, Repair, and Plastic Eye Procedures	J1	26.5709	$2,428.98	$485.80	76 / 0
5504	Level 4 Extraocular, Repair, and Plastic Eye Procedures	J1	43.9375	$4,016.55	$803.31	47 / 0
5521	Level 1 Imaging without Contrast	S	0.9726	$88.91	$17.79	79 / 1
5522	Level 2 Imaging without Contrast	S	1.1684	$106.81	$21.37	122 / 1
5523	Level 3 Imaging without Contrast	S	2.6666	$243.77	$48.76	65 / 6
5524	Level 4 Imaging without Contrast	S	6.1068	$558.25	$111.65	18 / 2
5571	Level 1 Imaging with Contrast	S	1.9603	$179.20	$35.84	50 / 1
5572	Level 2 Imaging with Contrast	S	3.8990	$356.43	$71.29	49 / 17
5573	Level 3 Imaging with Contrast	S	8.7611	$800.90	$160.18	13 / 9
5591	Level 1 Nuclear Medicine and Related Services	S	4.4679	$408.43	$81.69	65 / 1
5592	Level 2 Nuclear Medicine and Related Services	S	6.0683	$554.73	$110.95	29 / 0
5593	Level 3 Nuclear Medicine and Related Services	S	14.4691	$1,322.69	$264.54	15 / 0
5594	Level 4 Nuclear Medicine and Related Services	S	15.9812	$1,460.92	$292.19	11 / 0
5611	Level 1 Therapeutic Radiation Treatment Preparation	S	1.5022	$137.32	$27.47	10 / 0
5612	Level 2 Therapeutic Radiation Treatment Preparation	S	4.1846	$382.54	$76.51	10 / 0
5613	Level 3 Therapeutic Radiation Treatment Preparation	S	15.4691	$1,414.11	$282.83	5 / 1
5621	Level 1 Radiation Therapy	S	1.1403	$104.24	$20.85	5 / 0
5622	Level 2 Radiation Therapy	S	4.3106	$394.05	$78.81	5 / 0
5623	Level 3 Radiation Therapy	S	6.1752	$564.51	$112.91	9 / 0
5624	Level 4 Radiation Therapy	S	7.7838	$711.56	$142.32	7 / 0
5625	Level 5 Radiation Therapy	S	13.9672	$1,276.81	$255.37	3 / 0
5626	Level 6 Radiation Therapy	S	19.9834	$1,826.78	$365.36	1 / 0
5627	Level 7 Radiation Therapy	J1	82.3149	$7,524.82	$1,504.97	4 / 0
5661	Therapeutic Nuclear Medicine	S	2.6078	$238.39	$47.68	8 / 0
5671	Level 1 Pathology	S	0.5824	$53.24	$10.65	26 / 0
5672	Level 2 Pathology	S	1.9041	$174.06	$34.82	54 / 0
5673	Level 3 Pathology	S	4.0060	$366.21	$73.25	9 / 1
5674	Level 4 Pathology	S	9.0043	$823.13	$164.63	10 / 0
5691	Level 1 Drug Administration	S	0.5233	$47.84	$9.57	15 / 3
5692	Level 2 Drug Administration	S	0.8047	$73.56	$14.72	14 / 1
5693	Level 3 Drug Administration	S	2.3772	$217.31	$43.47	9 / 1
5694	Level 4 Drug Administration	S	3.6915	$337.46	$67.50	16 / 1
5721	Level 1 Diagnostic Tests and Related Services	S	1.4381	$131.46	$26.30	62 / 2
5722	Level 2 Diagnostic Tests and Related Services	S	2.4132	$220.60	$44.12	74 / 4
5723	Level 3 Diagnostic Tests and Related Services	S	4.1704	$381.24	$76.25	44 / 4
5724	Level 4 Diagnostic Tests and Related Services	S	9.5973	$877.34	$175.47	26 / 2
5731	Level 1 Minor Procedures	S	0.3232	$29.55	$5.91	32 / 8
5732	Level 2 Minor Procedures	S	0.4174	$38.16	$7.64	46 / 5
5733	Level 3 Minor Procedures	S	0.6593	$60.27	$12.06	76 / 2
5734	Level 4 Minor Procedures	S	1.4870	$135.93	$27.19	91 / 2
5735	Level 5 Minor Procedures	S	4.9926	$456.40	$91.28	29 / 3
5741	Level 1 Electronic Analysis of Devices	S	0.4171	$38.13	$7.63	51 / 0
5742	Level 2 Electronic Analysis of Devices	S	1.0625	$97.13	$19.43	17 / 0
5743	Level 3 Electronic Analysis of Devices	S	3.4326	$313.79	$62.76	10 / 0
5771	Cardiac Rehabilitation	S	1.4407	$131.70	$26.34	2 / 2
5781	Resuscitation and Cardioversion	S	7.3867	$675.26	$135.06	4 / 0
5791	Pulmonary Treatment	S	2.4473	$223.72	$44.75	7 / 0
5801	Ventilation Initiation and Management	S	6.9045	$631.17	$126.24	2 / 0
5811	Manipulation Therapy	S	0.2413	$22.06	$4.42	8 / 0
5821	Level 1 Health and Behavior Services	S	0.4187	$38.28	$7.66	14 / 14
5822	Level 2 Health and Behavior Services	S	1.1354	$103.79	$20.76	12 / 16
5823	Level 3 Health and Behavior Services	S	1.9837	$181.34	$36.27	14 / 3
5851	Intensive Outpatient (3 services) for CMHCs	P	1.3974	$127.74	$25.55	—
5852	Intensive Outpatient (4 or more services) for CMHCs	P	1.8310	$167.38	$33.48	—
5853	Partial Hospitalization (3 services) for CMHCs	P	1.3974	$127.74	$25.55	—
5854	Partial Hospitalization (4 or more services) for CMHCs	P	1.8310	$167.38	$33.48	—
5861	Intensive Outpatient (3 services) for Hospital-based IOPs	P	3.4937	$319.38	$63.88	—
5862	Intensive Outpatient (4 or more services) for Hospital-based IOPs	P	4.5775	$418.45	$83.69	—
5863	Partial Hospitalization (3 services) for Hospital-based PHPs	P	3.4937	$319.38	$63.88	—
5864	Partial Hospitalization (4 or more services) for Hospital-based PHPs	P	4.5775	$418.45	$83.69	—
5871	Dental Procedures	T	7.2252	$660.49	$132.10	—
5881	Ancillary Outpatient Services When Patient DiesCopayment capped at the inpatient deductible	J1	155.6515	$14,228.88	$2,845.78	—
6000	PMA Skin Substitute Products	S1	1.3908	$127.14	$25.43	0 / 7
6001	510K Skin Substitute Products	S1	1.3908	$127.14	$25.43	0 / 70
6002	HCT/P Skin Substitute Products	S1	1.3908	$127.14	$25.43	0 / 251
8004	Ultrasound Composite	S	3.2880	$300.57	$60.12	—
8005	CT and CTA without Contrast Composite	S	2.4730	$226.07	$45.22	—
8006	CT and CTA with Contrast Composite	S	4.8012	$438.90	$87.78	—
8007	MRI and MRA without Contrast Composite	S	5.8836	$537.85	$107.57	—
8008	MRI and MRA with Contrast Composite	S	9.4851	$867.08	$173.42	—
8010	Mental Health Services Composite	S	4.5775	$418.45	$83.69	—
8011	Comprehensive Observation Services	J2	29.2310	$2,672.15	$534.43	—
9398	Covid-19 Vaccine Administration	S	0.4542	$41.52	$0.00	1 / 0
9399	Pneumococcal, Influenza, Hepatitis B, and/or Covid-19 Vaccine Home Administration	S	0.4031	$36.85	$0.00	0 / 1

HCPCS Level II codes by APC

65 clinical APCs include HCPCS Level II codes, 540 in all. 328 of them are skin substitute products in APCs 6000-6002, which CMS pays by product class (premarket approval, 510(k) clearance or human tissue); the rest are hospital visit, screening and counseling G codes, C codes for hospital outpatient services and a few Q and A codes. Codes with an indexed reference page link to it; the page shows the code's OPPS status, MUE and payment in every other fee schedule. CPT members are counted above and can be checked one at a time in the Medicare fee lookup, which returns the status indicator, APC and rate for any code.

APC 5012 Clinic Visits and Related Services: 8 Level II codes

G0245 Initial foot exam pt lops
G0246 Followup eval of foot pt lop
G0248 Demonstrate use home inr mon
G0249 Provide inr test mater/equip
G0402 Initial preventive exam
G0463 Hospital outpt clinic visit
G0553 Monthly tx for dmht 20mins

G0552

APC 5024 Level 4 Type A ED Visits: 1 Level II code

G0175 Opps service,sched team conf

APC 5025 Level 5 Type A ED Visits: 1 Level II code

G0379 Direct refer hospital observ

APC 5031 Level 1 Type B ED Visits: 1 Level II code

G0380 Lev 1 hosp type b ed visit

APC 5032 Level 2 Type B ED Visits: 1 Level II code

G0381 Lev 2 hosp type b ed visit

APC 5033 Level 3 Type B ED Visits: 1 Level II code

G0382 Lev 3 hosp type b ed visit

APC 5034 Level 4 Type B ED Visits: 1 Level II code

G0383 Lev 4 hosp type b ed visit

APC 5035 Level 5 Type B ED Visits: 1 Level II code

G0384

APC 5045 Trauma Response with Critical Care: 1 Level II code

G0390 Trauma respons w/hosp criti

APC 5051 Level 1 Skin Procedures: 1 Level II code

G0247 Routine footcare pt w lops

APC 5054 Level 4 Skin Procedures: 3 Level II codes

G0429 Dermal filler injection(s)
G0460 Autolog prp not diab ulcer
G0465 Autolog prp diab wound ulcer

APC 5061 Hyperbaric Oxygen: 1 Level II code

G0277 Hbot, full body chamber, 30m

APC 5113 Level 3 Musculoskeletal Procedures: 1 Level II code

G0415

APC 5114 Level 4 Musculoskeletal Procedures: 4 Level II codes

G0413 Pelvic ring fracture uni/bil

G0276, G0412, G0414

APC 5115 Level 5 Musculoskeletal Procedures: 3 Level II codes

C9757 Spine device implant surgery
C9781 Arthro/shoul surg; w/spacer

C9734

APC 5116 Level 6 Musculoskeletal Procedures: 1 Level II code

C8003 Imp extar knee shck absrb

APC 5163 Level 3 ENT Procedures: 1 Level II code

C9727

APC 5164 Level 4 ENT Procedures: 1 Level II code

G0330 Facility svs dental rehab

APC 5193 Level 3 Endovascular Procedures: 6 Level II codes

C8004 Sim ang w/prs cath rad emb
C9600 Perc drug-el cor stent sing
C9604 Perc d-e cor revasc t cabg s
C9764 Revasc intravasc lithotripsy

C9772, C9783

APC 5194 Level 4 Endovascular Procedures: 9 Level II codes

C9602 Perc d-e cor stent ather s
C9607 Perc d-e cor revasc chro sin
C9765 Revasc intra lithotrip-stent
C9766 Revasc intra lithotrip-ather
C9797 Vasc emb/occ w/prs cath

C9767, C9773, C9774, C9775

APC 5303 Level 3 Upper GI Procedures: 2 Level II codes

C9777 Esophag muc integ w/eso egd
C9779 Esd endoscopy or colonoscopy

APC 5311 Level 1 Lower GI Procedures: 5 Level II codes

G0104 Ca screen;flexi sigmoidscope
G0105 Colorectal scrn; hi risk ind
G0121 Colon ca scrn not hi rsk ind

C9725, G0455

APC 5313 Level 3 Lower GI Procedures: 1 Level II code

C9796

APC 5342 Level 2 Abdominal/Peritoneal/Biliary and Related Procedures: 1 Level II code

C8006

APC 5362 Level 2 Laparoscopy and Related Services: 2 Level II codes

C9785 Endo outlet restrict w/tube
C9901 Endo defect closure gi tract

APC 5375 Level 5 Urology and Related Services: 2 Level II codes

C9739 Cystoscopy prostatic imp 1-3

C8014

APC 5376 Level 6 Urology and Related Services: 2 Level II codes

C9740 Cysto impl 4 or more
C9761 Cysto, litho, vacuum kidney

APC 5401 Dialysis: 1 Level II code

G0257 Unsched dialysis esrd pt hos

APC 5415 Level 5 Gynecologic Procedures: 1 Level II code

C9778

APC 5432 Level 2 Nerve Procedures: 2 Level II codes

C8009, C8013

APC 5442 Level 2 Nerve Injections: 1 Level II code

G0260 Inj for sacroiliac jt anesth

APC 5463 Level 3 Neurostimulator and Related Procedures: 2 Level II codes

C8008 Rv/rpl hpgls ns inc cnt pg

C8012

APC 5465 Level 5 Neurostimulator and Related Procedures: 2 Level II codes

C8007 Opn mplnt hpgls ns ary ps gn

C8011

APC 5481 Laser Eye Procedures: 1 Level II code

G0186

APC 5521 Level 1 Imaging without Contrast: 1 Level II code

G0183

APC 5522 Level 2 Imaging without Contrast: 1 Level II code

G0130 Single energy x-ray study

APC 5523 Level 3 Imaging without Contrast: 6 Level II codes

C8901, C8910, C8913, C8919, C8932, C8935

APC 5524 Level 4 Imaging without Contrast: 2 Level II codes

C9762, C9763

APC 5571 Level 1 Imaging with Contrast: 1 Level II code

C8903

APC 5572 Level 2 Imaging with Contrast: 17 Level II codes

C8908 Mri w/o fol w/cont, breast,
C8924 2d tte w or w/o fol w/con,fu

C8900, C8902, C8905, C8906, C8909, C8911, C8912, C8914, C8918, C8920, C8931, C8933, C8934, C8936, C9733

APC 5573 Level 3 Imaging with Contrast: 9 Level II codes

C8928 Tte w or w/o fol w/con,stres
C8929 Tte w or wo fol wcon,doppler
C8930 Tte w or w/o contr, cont ecg

C8921, C8922, C8923, C8925, C8926, C8927

APC 5591 Level 1 Nuclear Medicine and Related Services: 1 Level II code

G0235

APC 5613 Level 3 Therapeutic Radiation Treatment Preparation: 1 Level II code

C9728

APC 5673 Level 3 Pathology: 1 Level II code

G0416 Prostate biopsy, any mthd

APC 5691 Level 1 Drug Administration: 3 Level II codes

G0008 Admin influenza virus vac
G0009 Admin pneumococcal vaccine
G0010 Admin hepatitis b vaccine

APC 5692 Level 2 Drug Administration: 1 Level II code

G0012

APC 5693 Level 3 Drug Administration: 1 Level II code

C8957

APC 5694 Level 4 Drug Administration: 1 Level II code

G0498 Chemo extend iv infus w/pump

APC 5721 Level 1 Diagnostic Tests and Related Services: 2 Level II codes

C8001, G0566

APC 5722 Level 2 Diagnostic Tests and Related Services: 4 Level II codes

G0398 Home sleep test/type 2 porta
G0399 Home sleep test/type 3 porta
G0400 Home sleep test/type 4 porta

G0303

APC 5723 Level 3 Diagnostic Tests and Related Services: 4 Level II codes

G2000 Blinded conv. tx mdd clin tr

G0302, G0304, G0305

APC 5724 Level 4 Diagnostic Tests and Related Services: 2 Level II codes

C9793, G0555

APC 5731 Level 1 Minor Procedures: 8 Level II codes

G0117 Glaucoma scrn hgh risk direc
G0237 Therapeutic procd strg endur
G0238 Oth resp proc, indiv
G0404 Ekg tracing for initial prev
G0541 No pt prsnt train initial 30
G2011 Alcohol/sub misuse assess
Q0091 Obtaining screen pap smear

G0543

APC 5732 Level 2 Minor Procedures: 5 Level II codes

G0118 Glaucoma scrn hgh risk direc
G0239 Oth resp proc, group

G0293, G0294, Q0035

APC 5733 Level 3 Minor Procedures: 2 Level II codes

G0127 Trim nail(s)

P9100

APC 5734 Level 4 Minor Procedures: 2 Level II codes

G0166 Extrnl counterpulse, per tx

G0685

APC 5735 Level 5 Minor Procedures: 3 Level II codes

G0516 Insert drug del implant, >=4

G0517, G0518

APC 5771 Cardiac Rehabilitation: 2 Level II codes

G0422 Intens cardiac rehab w/exerc
G0423 Intens cardiac rehab no exer

APC 5821 Level 1 Health and Behavior Services: 14 Level II codes

G0013 Hiv prep counsel, clin staff
G0136 Adm of pa/n assess 5-15 m
G0323 Care manage beh svs 20mins
G0396 Alcohol/subs interv 15-30mn
G0442 Annual alcohol screen 15 min
G0444 Depression screen annual
G0446 Intens behave ther cardio dx
G0473 Group behave couns 2-10
G0537 Risk ascvd tst once pr 12 mo
G0557 Adv prim care mgmt lvl 2
G0570 Care manage serv, pr cal mo

C7900, C7903, G0556

APC 5822 Level 2 Health and Behavior Services: 16 Level II codes

G0019 Comm hlth intg svs sdoh 60mn
G0023 Pin service 60m per month
G0101 Ca screen;pelvic/breast exam
G0140 Nav srv peer sup 60 min pr m
G0296 Visit to determ ldct elig
G0443 Brief alcohol misuse counsel
G0445 High inten beh couns std 30m
G0447 Behavior counsel obesity 15m
G0451 Devlopment test interpt&rep
G0538 Ascvd rsk mng clin stf pr mo
G0544 Post d/c phone follow up
G2214 Init/sub psych care m 1st 30

C7901, G0558, G0568, G0569

APC 5823 Level 3 Health and Behavior Services: 3 Level II codes

G0397 Alcohol/subs interv >30 min
G2086 Off base opioid tx 70min
G2087 Off base opioid tx, 60 m

APC 6000 PMA Skin Substitute Products: 7 Level II codes

Q4101 Apligraf
Q4159 Affinity1 square cm

Q4105, Q4108, Q4182, Q4238, Q4431

APC 6001 510K Skin Substitute Products: 70 Level II codes

A2001 Innovamatrix ac, per sq cm
Q4158 Kerecis omega3, per sq cm

A2002, A2005, A2006, A2007, A2008, A2009, A2010, A2011, A2012, A2013, A2015, A2016, A2018, A2019, A2021, A2022, A2024, A2025, A2027, A2029, A2031, A2032, A2034, A2036, A2038, A2039, A2040, A2041, A2042, A2043, A2045, A2046, A2047, A2049, C9363, Q4102, Q4103, Q4104, Q4107, Q4110, Q4111, Q4116, Q4117, Q4122, Q4124, Q4127, Q4130, Q4135, Q4136, Q4146, Q4161, Q4164, Q4165, Q4166, Q4175, Q4195, Q4196, Q4197, Q4198, Q4201, Q4203, Q4222, Q4225, Q4232, Q4276, Q4282, Q4297, Q4432

APC 6002 HCT/P Skin Substitute Products: 251 Level II codes

Q4133 Grafix stravix prime pl sqcm
Q4186 Epifix 1 sq cm
Q4191 Restorigin 1 sq cm
Q4221 Amniowrap2 per sq cm
Q4250 Amnioamp-mp per sq cm

Q4115, Q4121, Q4123, Q4125, Q4126, Q4128, Q4132, Q4134, Q4137, Q4138, Q4140, Q4141, Q4142, Q4143, Q4147, Q4148, Q4150, Q4151, Q4152, Q4153, Q4154, Q4156, Q4157, Q4160, Q4163, Q4167, Q4169, Q4170, Q4173, Q4176, Q4178, Q4179, Q4180, Q4181, Q4183, Q4184, Q4187, Q4188, Q4190, Q4193, Q4194, Q4199, Q4200, Q4204, Q4205, Q4207, Q4208, Q4209, Q4211, Q4214, Q4216, Q4217, Q4218, Q4219, Q4220, Q4223, Q4227, Q4229, Q4234, Q4235, Q4236, Q4237, Q4239, Q4243, Q4247, Q4248, Q4249, Q4251, Q4252, Q4253, Q4254, Q4255, Q4256, Q4257, Q4258, Q4259, Q4260, Q4261, Q4262, Q4263, Q4264, Q4265, Q4266, Q4267, Q4268, Q4269, Q4270, Q4271, Q4272, Q4273, Q4274, Q4275, Q4278, Q4279, Q4280, Q4281, Q4283, Q4284, Q4285, Q4286, Q4287, Q4288, Q4289, Q4290, Q4291, Q4292, Q4293, Q4294, Q4295, Q4296, Q4298, Q4299, Q4300, Q4301, Q4302, Q4303, Q4304, Q4305, Q4306, Q4307, Q4308, Q4309, Q4311, Q4312, Q4313, Q4314, Q4315, Q4316, Q4317, Q4318, Q4319, Q4320, Q4321, Q4322, Q4323, Q4324, Q4325, Q4326, Q4327, Q4328, Q4329, Q4330, Q4331, Q4332, Q4333, Q4334, Q4335, Q4336, Q4337, Q4338, Q4339, Q4340, Q4341, Q4342, Q4343, Q4344, Q4345, Q4346, Q4347, Q4348, Q4349, Q4350, Q4351, Q4352, Q4353, Q4354, Q4355, Q4356, Q4357, Q4358, Q4359, Q4360, Q4361, Q4362, Q4363, Q4364, Q4365, Q4366, Q4367, Q4368, Q4369, Q4370, Q4371, Q4372, Q4373, Q4375, Q4376, Q4377, Q4378, Q4379, Q4380, Q4382, Q4383, Q4384, Q4385, Q4386, Q4387, Q4388, Q4389, Q4390, Q4391, Q4392, Q4393, Q4394, Q4395, Q4396, Q4397, Q4398, Q4399, Q4400, Q4401, Q4402, Q4403, Q4404, Q4405, Q4406, Q4407, Q4408, Q4409, Q4410, Q4411, Q4412, Q4413, Q4414, Q4415, Q4416, Q4417, Q4418, Q4419, Q4420, Q4421, Q4422, Q4423, Q4424, Q4425, Q4426, Q4427, Q4428, Q4429, Q4433, Q4435, Q4436, Q4437, Q4438, Q4439, Q4440

APC 9399 Pneumococcal, Influenza, Hepatitis B, and/or Covid-19 Vaccine Home Administration: 1 Level II code

M0201 Pne flu hepb cov home admin

New Technology APCs

A service too new to have claims data is assigned to a New Technology APC whose payment band matches its expected cost, until enough claims exist to move it to a clinical APC. Each band exists twice, once with status S and once with status T, so the multiple-procedure discount can follow the service. 24 of the 112 New Technology APCs have codes assigned in October 2026.

New Technology APCs in the October 2026 OPPS Addendum A
APC	Cost band	SI	Rate	Codes
1491	$0 to $10	S	$5.00	—
1492	$11 to $20	S	$15.50	1
1493	$21 to $30	S	$25.50	—
1494	$31 to $40	S	$35.50	—
1495	$41 to $50	S	$45.50	—
1496	$0 to $10	T	$5.00	—
1497	$11 to $20	T	$15.50	—
1498	$21 to $30	T	$25.50	—
1499	$31 to $40	T	$35.50	—
1500	$41 to $50	T	$45.50	—
1502	$51 to $100	S	$75.50	—
1503	$101 to $200	S	$150.50	—
1504	$201 to $300	S	$250.50	—
1505	$301 to $400	S	$350.50	2
1506	$401 to $500	S	$450.50	11
1507	$501 to $600	S	$550.50	—
1508	$601 to $700	S	$650.50	5
1509	$701 to $800	S	$750.50	—
1510	$801 to $900	S	$850.50	1
1511	$901 to $1,000	S	$950.50	8
1512	$1,001 to $1,100	S	$1,050.50	1
1513	$1,101 to $1,200	S	$1,150.50	—
1514	$1,201 to $1,300	S	$1,250.50	—
1515	$1,301 to $1,400	S	$1,350.50	—
1516	$1,401 to $1,500	S	$1,450.50	1
1517	$1,501 to $1,600	S	$1,550.50	1
1518	$1,601 to $1,700	S	$1,650.50	1
1519	$1,701 to $1,800	S	$1,750.50	—
1520	$1,801 to $1,900	S	$1,850.50	—
1521	$1,901 to $2,000	S	$1,950.50	1
1522	$2,001 to $2,500	S	$2,250.50	2
1523	$2,501 to $3,000	S	$2,750.50	—
1524	$3,001 to $3,500	S	$3,250.50	1
1525	$3,501 to $4,000	S	$3,750.50	3
1526	$4,001 to $4,500	S	$4,250.50	—
1527	$4,501 to $5,000	S	$4,750.50	—
1528	$5,001 to $5,500	S	$5,250.50	—
1529	$5,501 to $6,000	S	$5,750.50	—
1530	$6,001 to $6,500	S	$6,250.50	—
1531	$6,501 to $7,000	S	$6,750.50	—
1532	$7,001 to $7,500	S	$7,250.50	2
1533	$7,501 to $8,000	S	$7,750.50	—
1534	$8,001 to $8,500	S	$8,250.50	1
1535	$8,501 to $9,000	S	$8,750.50	—
1536	$9,001 to $9,500	S	$9,250.50	—
1537	$9,501 to $10,000	S	$9,750.50	1
1539	$51 to $100	T	$75.50	—
1540	$101 to $200	T	$150.50	—
1541	$201 to $300	T	$250.50	—
1542	$301 to $400	T	$350.50	—
1543	$401 to $500	T	$450.50	—
1544	$501 to $600	T	$550.50	—
1545	$601 to $700	T	$650.50	—
1546	$701 to $800	T	$750.50	—
1547	$801 to $900	T	$850.50	—
1548	$901 to $1,000	T	$950.50	—
1549	$1,001 to $1,100	T	$1,050.50	—
1550	$1,101 to $1,200	T	$1,150.50	—
1551	$1,201 to $1,300	T	$1,250.50	2
1552	$1,301 to $1,400	T	$1,350.50	—
1553	$1,401 to $1,500	T	$1,450.50	—
1554	$1,501 to $1,600	T	$1,550.50	—
1555	$1,601 to $1,700	T	$1,650.50	—
1556	$1,701 to $1,800	T	$1,750.50	—
1557	$1,801 to $1,900	T	$1,850.50	—
1558	$1,901 to $2,000	T	$1,950.50	—
1559	$2,001 to $2,500	T	$2,250.50	—
1560	$2,501 to $3,000	T	$2,750.50	—
1561	$3,001 to $3,500	T	$3,250.50	—
1562	$3,501 to $4,000	T	$3,750.50	—
1563	$4,001 to $4,500	T	$4,250.50	3
1564	$4,501 to $5,000	T	$4,750.50	—
1565	$5,001 to $5,500	T	$5,250.50	—
1566	$5,501 to $6,000	T	$5,750.50	—
1567	$6,001 to $6,500	T	$6,250.50	—
1568	$6,501 to $7,000	T	$6,750.50	—
1569	$7,001 to $7,500	T	$7,250.50	—
1570	$7,501 to $8,000	T	$7,750.50	—
1571	$8,001 to $8,500	T	$8,250.50	—
1572	$8,501 to $9,000	T	$8,750.50	—
1573	$9,001 to $9,500	T	$9,250.50	—
1574	$9,501 to $10,000	T	$9,750.50	—
1575	$10,001 to $15,000	S	$12,500.50	—
1576	$15,001 to $20,000	S	$17,500.50	4
1577	$20,001 to $25,000	S	$22,500.50	—
1578	$25,001 to $30,000	S	$27,500.50	—
1579	$30,001 to $40,000	S	$35,000.50	1
1580	$40,001 to $50,000	S	$45,000.50	5
1581	$50,001 to $60,000	S	$55,000.50	—
1582	$60,001 to $70,000	S	$65,000.50	—
1583	$70,001 to $80,000	S	$75,000.50	—
1584	$80,001 to $90,000	S	$85,000.50	—
1585	$90,001 to $100,000	S	$95,000.50	—
1589	$10,001 to $15,000	T	$12,500.50	—
1590	$15,001 to $20,000	T	$17,500.50	2
1591	$20,001 to $25,000	T	$22,500.50	—
1592	$25,001 to $30,000	T	$27,500.50	1
1593	$30,001 to $40,000	T	$35,000.50	—
1594	$40,001 to $50,000	T	$45,000.50	—
1595	$50,001 to $60,000	T	$55,000.50	—
1596	$60,001 to $70,000	T	$65,000.50	—
1597	$70,001 to $80,000	T	$75,000.50	—
1598	$80,001 to $90,000	T	$85,000.50	—
1599	$90,001 to $100,000	T	$95,000.50	—
1901	$100,001 to $115,000	S	$107,500.50	—
1902	$100,001 to $115,000	T	$107,500.50	—
1903	$115,001 to $130,000	S	$122,500.50	—
1904	$115,001 to $130,000	T	$122,500.50	—
1905	$130,001 to $145,000	S	$137,500.50	—
1906	$130,001 to $145,000	T	$137,500.50	—
1907	$145,001 to $160,000	S	$152,500.50	—
1908	$145,001 to $160,000	T	$152,500.50	—

APCs that pay drugs, devices and blood

The other 757 rows of Addendum A give separately payable products their own APC so the claim can carry a per-unit rate: drugs and biologicals, generally paid at average sales price plus an add-on, pass-through drugs and devices, non-opioid products for post-surgical pain relief, blood products and brachytherapy sources. Their group titles are product descriptors, so this reference counts them by status indicator; the ASP pricing file page covers drug payment limits.

Non-clinical APCs in the October 2026 Addendum A by status indicator
SI	What the APCs pay	APCs
K	Nonpass-Through Drugs and Nonimplantable Biologicals, Including Radiopharmaceuticals	552
G	Drug/Biological Pass-through	106
R	Blood and blood products	41
H	Pass-through device categories	21
U	Brachytherapy sources	17
H1	Non-Opioid Medical Devices for Post-Surgical Pain Relief	13
K1	Non-Opioid Drugs and Biologicals for Post-Surgical Pain Relief	7

Where QuickIntell fits for hospital outpatient claims

QuickRCM covers claim readiness, denials and posting for hospital outpatient claims with configurable automation and human review, which is where a line's status indicator, packaging and the comprehensive APC on the claim decide what the payer should pay.

See QuickRCM See contract management Book a meeting

Frequently asked questions

What is an APC?

An ambulatory payment classification is the group the hospital outpatient prospective payment system (OPPS) pays a service through. Services that are clinically similar and use similar resources share an APC, and every code in it is paid the APC rate. The October 2026 Addendum A has 1,061 APCs, 304 of them for procedures and services.

How is an APC payment calculated?

The national payment rate is the APC's relative weight times the OPPS conversion factor; in the October 2026 Addendum A the rates work out to about $91.415 per unit of weight. For each hospital, 60 percent of the rate (the labor-related share) is adjusted by its wage index, and the beneficiary copayment is set nationally, never above the inpatient deductible of $1,736.00 for one service.

What is a comprehensive APC?

A comprehensive APC (status indicator J1) pays one amount for the primary procedure on the claim and packages most other services into it. 73 of the October 2026 APCs are comprehensive; comprehensive observation (J2) is paid through APC 8011 when the claim qualifies.

What is a New Technology APC?

A payment band for a new service that has too little claims data for a clinical APC. CMS assigns the service to the band that matches its expected cost, either with status S (not discounted) or T (multiple-procedure discounting applies). The October 2026 file lists 112 New Technology APCs, from $5.00 to $152,500.50.

Which APC pays a hospital outpatient clinic visit?

APC 5012, Clinic Visits and Related Services, at $136.02 in the October 2026 file (status indicator V). Emergency department visits are paid through the Type A and Type B ED visit APCs, five levels each.

How is an APC different from an MS-DRG?

Both group services for prospective payment, but MS-DRGs pay a whole inpatient stay per discharge under IPPS, while APCs pay hospital outpatient services line by line (or per claim for comprehensive APCs) under OPPS. A single outpatient claim can carry several APC payments.

Related: the OPPS status indicators, the MS-DRG reference for inpatient stays and the I/OCE edit list for the edits that return outpatient claim lines.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

OPPS Addendum A (APCs), October 2026
Version October 2026 · effective 2026-10-01 · file 508-compliant-version-2026 October Web Addendum A.09.18.26.txtSHA-256 2a809862a8ec6096…
OPPS Addendum B, October 2026
Version October 2026 · effective 2026-10-01 · file 508-compliant-version-2026_October_Web_Addendum_B.09.28.26.csvSHA-256 6ad7393a318bf1b9…
Integrated Outpatient Code Editor v27.3 data tables: status and payment indicators
Version I/OCE v27.3 (October 2026) · effective 2026-10-01 · file Data_Status_Indicator.txtSHA-256 78f119ef0a435351…
HCPCS Level II alpha-numeric file, October 2026
Version October 2026 · effective 2026-10-01 · file HCPC2026_OCT_ANWEB_09232026.txtSHA-256 c25240c63108756d…

Disclaimer

Operational reference compiled from the CMS hospital outpatient quarterly addenda. Rates are national unadjusted amounts before the wage index and other hospital-specific adjustments; payers other than Medicare set their own rates. CPT codes are counted, never described; CPT descriptors are copyright AMA. Not legal, coding or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.

APC list 2026: ambulatory payment classifications (October OPPS)