What is the payment rate for APC 04003?

The Medicare payment rate for Ambulatory Payment Classification (APC) 04003 is currently $145.10. This rate is determined under the Outpatient Prospective Payment System (OPPS).

What does the status indicator 'S' mean for APC 04003?

APC 04003 is assigned status indicator 'S'. Status indicators determine how services are paid under OPPS, including whether they are separately payable or packaged.

Is APC 04003 subject to special Mental Health or Emergency Room logic?

No, APC 04003 is not flagged for special Mental Health or ER observation logic in the current version.

APC 04003 - Description and IOCE Data

v26.0.6 – v26.3.3 (2025-01-01 to 2025-12-31) $145.10

Description

"Radiation treatment delivery, MeV <= 5; simple"

Core Attributes

Payment Amount: $145.10
Status Indicator? Status indicator assigned to the APC: S
Payment Indicator? Payment indicator assigned to the APC: 1

Processing Flags

Mental Health ? APC subject to Mental Health/Partial Hospitalization Program (MH/PHP) logic. Values: 0 = not applicable 1 = applicable: No
Device Offset ? APC's device offset amount prior to v54. Refer to OFFSET_CODEPAIRS table for device offset amounts after v53.: 0
Comp2 Id ? APC subject to observation composite APC processing prior to v62 (Note: EA&M composite levels I & II combined in v18.0). Values: 0 = not applicable 1 = possible level II observation composite APC 2 = possible level I observation composite APC: 0
Nuc Rad Fb ? APC subject to nuclear medicine/radiopharm processing prior to v54. Values: 0 = not applicable 1 = applicable: 0
Er Visit ? Emergency room visit and critical care APC subject to observation logic. Values: 0 = not applicable 1 = applicable: No
Comp1 Id ? APC subject to composite APC processing. Values: 0 = not applicable 1 = electrophysiology/ablation composite APC (v15.3) 2 = LDR prostate brachytherapy composite APC (v18.3): 0
Comp3 Id ? APC subject to multiple imaging composite APC processing. Values: 0 = not applicable 1 = Ultrasound Composite 2 = CT and CTA without Contrast Composite 3 = CT and CTA with Contrast Composite 4 = MRI and MRA without Contrast Composite 5 = MRI and MRA with Contrast Composite: 0
Capc Srs ? APC subject to comprehensive APC processing for Stereotactic Radiosurgery (SRS). Values: 0 = not applicable 1 = applicable: 0

v25.0.10 – v25.3.7 (2024-01-01 to 2024-12-31) $147.18

Description

"Radiation treatment delivery, MeV <= 5; simple"

Core Attributes

Payment Amount: $147.18
Status Indicator? Status indicator assigned to the APC: S
Payment Indicator? Payment indicator assigned to the APC: 1

Processing Flags

Mental Health ? APC subject to Mental Health/Partial Hospitalization Program (MH/PHP) logic. Values: 0 = not applicable 1 = applicable: No
Device Offset ? APC's device offset amount prior to v54. Refer to OFFSET_CODEPAIRS table for device offset amounts after v53.: 0
Comp2 Id ? APC subject to observation composite APC processing prior to v62 (Note: EA&M composite levels I & II combined in v18.0). Values: 0 = not applicable 1 = possible level II observation composite APC 2 = possible level I observation composite APC: 0
Nuc Rad Fb ? APC subject to nuclear medicine/radiopharm processing prior to v54. Values: 0 = not applicable 1 = applicable: 0
Er Visit ? Emergency room visit and critical care APC subject to observation logic. Values: 0 = not applicable 1 = applicable: No
Comp1 Id ? APC subject to composite APC processing. Values: 0 = not applicable 1 = electrophysiology/ablation composite APC (v15.3) 2 = LDR prostate brachytherapy composite APC (v18.3): 0
Comp3 Id ? APC subject to multiple imaging composite APC processing. Values: 0 = not applicable 1 = Ultrasound Composite 2 = CT and CTA without Contrast Composite 3 = CT and CTA with Contrast Composite 4 = MRI and MRA without Contrast Composite 5 = MRI and MRA with Contrast Composite: 0
Capc Srs ? APC subject to comprehensive APC processing for Stereotactic Radiosurgery (SRS). Values: 0 = not applicable 1 = applicable: 0

v24.0.14 – v24.3.11 (2023-01-01 to 2023-12-31) $146.92

Description

"Radiation treatment delivery, MeV <= 5; simple"

Core Attributes

Payment Amount: $146.92
Status Indicator? Status indicator assigned to the APC: S
Payment Indicator? Payment indicator assigned to the APC: 1

Processing Flags

Mental Health ? APC subject to Mental Health/Partial Hospitalization Program (MH/PHP) logic. Values: 0 = not applicable 1 = applicable: No
Device Offset ? APC's device offset amount prior to v54. Refer to OFFSET_CODEPAIRS table for device offset amounts after v53.: 0
Comp2 Id ? APC subject to observation composite APC processing prior to v62 (Note: EA&M composite levels I & II combined in v18.0). Values: 0 = not applicable 1 = possible level II observation composite APC 2 = possible level I observation composite APC: 0
Nuc Rad Fb ? APC subject to nuclear medicine/radiopharm processing prior to v54. Values: 0 = not applicable 1 = applicable: 0
Er Visit ? Emergency room visit and critical care APC subject to observation logic. Values: 0 = not applicable 1 = applicable: No
Comp1 Id ? APC subject to composite APC processing. Values: 0 = not applicable 1 = electrophysiology/ablation composite APC (v15.3) 2 = LDR prostate brachytherapy composite APC (v18.3): 0
Comp3 Id ? APC subject to multiple imaging composite APC processing. Values: 0 = not applicable 1 = Ultrasound Composite 2 = CT and CTA without Contrast Composite 3 = CT and CTA with Contrast Composite 4 = MRI and MRA without Contrast Composite 5 = MRI and MRA with Contrast Composite: 0
Capc Srs ? APC subject to comprehensive APC processing for Stereotactic Radiosurgery (SRS). Values: 0 = not applicable 1 = applicable: 0

v23.0.18 – v23.3.15 (2022-01-01 to 2022-12-31) $153.18

Description

"Radiation treatment delivery, MeV <= 5; simple"

Core Attributes

Payment Amount: $153.18
Status Indicator? Status indicator assigned to the APC: S
Payment Indicator? Payment indicator assigned to the APC: 1

Processing Flags

Mental Health ? APC subject to Mental Health/Partial Hospitalization Program (MH/PHP) logic. Values: 0 = not applicable 1 = applicable: No
Device Offset ? APC's device offset amount prior to v54. Refer to OFFSET_CODEPAIRS table for device offset amounts after v53.: 0
Comp2 Id ? APC subject to observation composite APC processing prior to v62 (Note: EA&M composite levels I & II combined in v18.0). Values: 0 = not applicable 1 = possible level II observation composite APC 2 = possible level I observation composite APC: 0
Nuc Rad Fb ? APC subject to nuclear medicine/radiopharm processing prior to v54. Values: 0 = not applicable 1 = applicable: 0
Er Visit ? Emergency room visit and critical care APC subject to observation logic. Values: 0 = not applicable 1 = applicable: No
Comp1 Id ? APC subject to composite APC processing. Values: 0 = not applicable 1 = electrophysiology/ablation composite APC (v15.3) 2 = LDR prostate brachytherapy composite APC (v18.3): 0
Comp3 Id ? APC subject to multiple imaging composite APC processing. Values: 0 = not applicable 1 = Ultrasound Composite 2 = CT and CTA without Contrast Composite 3 = CT and CTA with Contrast Composite 4 = MRI and MRA without Contrast Composite 5 = MRI and MRA with Contrast Composite: 0
Capc Srs ? APC subject to comprehensive APC processing for Stereotactic Radiosurgery (SRS). Values: 0 = not applicable 1 = applicable: 0

v22.1.21 – v22.3.19 (2021-04-01 to 2021-12-31) $156.67

Description

"Radiation treatment delivery, MeV <= 5; simple"

Core Attributes

Payment Amount: $156.67
Status Indicator? Status indicator assigned to the APC: S
Payment Indicator? Payment indicator assigned to the APC: 1

Processing Flags

Mental Health ? APC subject to Mental Health/Partial Hospitalization Program (MH/PHP) logic. Values: 0 = not applicable 1 = applicable: No
Device Offset ? APC's device offset amount prior to v54. Refer to OFFSET_CODEPAIRS table for device offset amounts after v53.: 0
Comp2 Id ? APC subject to observation composite APC processing prior to v62 (Note: EA&M composite levels I & II combined in v18.0). Values: 0 = not applicable 1 = possible level II observation composite APC 2 = possible level I observation composite APC: 0
Nuc Rad Fb ? APC subject to nuclear medicine/radiopharm processing prior to v54. Values: 0 = not applicable 1 = applicable: 0
Er Visit ? Emergency room visit and critical care APC subject to observation logic. Values: 0 = not applicable 1 = applicable: No
Comp1 Id ? APC subject to composite APC processing. Values: 0 = not applicable 1 = electrophysiology/ablation composite APC (v15.3) 2 = LDR prostate brachytherapy composite APC (v18.3): 0
Comp3 Id ? APC subject to multiple imaging composite APC processing. Values: 0 = not applicable 1 = Ultrasound Composite 2 = CT and CTA without Contrast Composite 3 = CT and CTA with Contrast Composite 4 = MRI and MRA without Contrast Composite 5 = MRI and MRA with Contrast Composite: 0
Capc Srs ? APC subject to comprehensive APC processing for Stereotactic Radiosurgery (SRS). Values: 0 = not applicable 1 = applicable: 0

v22.0.22 (2021-01-01 to 2021-03-31) $148.76

Description

"Radiation treatment delivery, MeV <= 5; simple"

Core Attributes

Payment Amount: $148.76
Status Indicator? Status indicator assigned to the APC: S
Payment Indicator? Payment indicator assigned to the APC: 1

Processing Flags

Mental Health ? APC subject to Mental Health/Partial Hospitalization Program (MH/PHP) logic. Values: 0 = not applicable 1 = applicable: No
Device Offset ? APC's device offset amount prior to v54. Refer to OFFSET_CODEPAIRS table for device offset amounts after v53.: 0
Comp2 Id ? APC subject to observation composite APC processing prior to v62 (Note: EA&M composite levels I & II combined in v18.0). Values: 0 = not applicable 1 = possible level II observation composite APC 2 = possible level I observation composite APC: 0
Nuc Rad Fb ? APC subject to nuclear medicine/radiopharm processing prior to v54. Values: 0 = not applicable 1 = applicable: 0
Er Visit ? Emergency room visit and critical care APC subject to observation logic. Values: 0 = not applicable 1 = applicable: No
Comp1 Id ? APC subject to composite APC processing. Values: 0 = not applicable 1 = electrophysiology/ablation composite APC (v15.3) 2 = LDR prostate brachytherapy composite APC (v18.3): 0
Comp3 Id ? APC subject to multiple imaging composite APC processing. Values: 0 = not applicable 1 = Ultrasound Composite 2 = CT and CTA without Contrast Composite 3 = CT and CTA with Contrast Composite 4 = MRI and MRA without Contrast Composite 5 = MRI and MRA with Contrast Composite: 0
Capc Srs ? APC subject to comprehensive APC processing for Stereotactic Radiosurgery (SRS). Values: 0 = not applicable 1 = applicable: 0

v21.0.26 – v21.3.23 (2020-01-01 to 2020-12-31) $194.01

Description

"Radiation treatment delivery, MeV <= 5; simple"

Core Attributes

Payment Amount: $194.01
Status Indicator? Status indicator assigned to the APC: S
Payment Indicator? Payment indicator assigned to the APC: 1

Processing Flags

Mental Health ? APC subject to Mental Health/Partial Hospitalization Program (MH/PHP) logic. Values: 0 = not applicable 1 = applicable: No
Device Offset ? APC's device offset amount prior to v54. Refer to OFFSET_CODEPAIRS table for device offset amounts after v53.: 0
Comp2 Id ? APC subject to observation composite APC processing prior to v62 (Note: EA&M composite levels I & II combined in v18.0). Values: 0 = not applicable 1 = possible level II observation composite APC 2 = possible level I observation composite APC: 0
Nuc Rad Fb ? APC subject to nuclear medicine/radiopharm processing prior to v54. Values: 0 = not applicable 1 = applicable: 0
Er Visit ? Emergency room visit and critical care APC subject to observation logic. Values: 0 = not applicable 1 = applicable: No
Comp1 Id ? APC subject to composite APC processing. Values: 0 = not applicable 1 = electrophysiology/ablation composite APC (v15.3) 2 = LDR prostate brachytherapy composite APC (v18.3): 0
Comp3 Id ? APC subject to multiple imaging composite APC processing. Values: 0 = not applicable 1 = Ultrasound Composite 2 = CT and CTA without Contrast Composite 3 = CT and CTA with Contrast Composite 4 = MRI and MRA without Contrast Composite 5 = MRI and MRA with Contrast Composite: 0
Capc Srs ? APC subject to comprehensive APC processing for Stereotactic Radiosurgery (SRS). Values: 0 = not applicable 1 = applicable: 0

v20.3.27 (2019-10-01 to 2019-12-31) $199.30

Description

"Radiation treatment delivery, MeV <= 5; simple"

Core Attributes

Payment Amount: $199.30
Status Indicator? Status indicator assigned to the APC: S
Payment Indicator? Payment indicator assigned to the APC: 1

Processing Flags

Mental Health ? APC subject to Mental Health/Partial Hospitalization Program (MH/PHP) logic. Values: 0 = not applicable 1 = applicable: No
Device Offset ? APC's device offset amount prior to v54. Refer to OFFSET_CODEPAIRS table for device offset amounts after v53.: 0
Comp2 Id ? APC subject to observation composite APC processing prior to v62 (Note: EA&M composite levels I & II combined in v18.0). Values: 0 = not applicable 1 = possible level II observation composite APC 2 = possible level I observation composite APC: 0
Nuc Rad Fb ? APC subject to nuclear medicine/radiopharm processing prior to v54. Values: 0 = not applicable 1 = applicable: 0
Er Visit ? Emergency room visit and critical care APC subject to observation logic. Values: 0 = not applicable 1 = applicable: No
Comp1 Id ? APC subject to composite APC processing. Values: 0 = not applicable 1 = electrophysiology/ablation composite APC (v15.3) 2 = LDR prostate brachytherapy composite APC (v18.3): 0
Comp3 Id ? APC subject to multiple imaging composite APC processing. Values: 0 = not applicable 1 = Ultrasound Composite 2 = CT and CTA without Contrast Composite 3 = CT and CTA with Contrast Composite 4 = MRI and MRA without Contrast Composite 5 = MRI and MRA with Contrast Composite: 0
Capc Srs ? APC subject to comprehensive APC processing for Stereotactic Radiosurgery (SRS). Values: 0 = not applicable 1 = applicable: 0

APC 04003

Historical IOCE Data

Description

Core Attributes

Processing Flags

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Processing Flags

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Processing Flags

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