APC 09122

v27.2.0 (2026-07-01 to 2036-06-30) $469.38

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$469.38

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v27.1.1 (2026-04-01 to 2026-06-30) $463.20

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$463.20

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v27.0.2 (2026-01-01 to 2026-03-31) $474.84

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$474.84

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v26.3.3 (2025-10-01 to 2025-12-31) $491.90

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$491.90

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v26.2.4 (2025-07-01 to 2025-09-30) $471.63

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$471.63

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v26.1.5 (2025-04-01 to 2025-06-30) $481.29

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$481.29

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v26.0.6 (2025-01-01 to 2025-03-31) $466.73

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$466.73

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v25.3.7 (2024-10-01 to 2024-12-31) $458.51

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$458.51

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v25.2.8 (2024-07-01 to 2024-09-30) $416.69

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$416.69

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v25.1.9 (2024-04-01 to 2024-06-30) $413.59

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$413.59

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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 (2024-01-01 to 2024-03-31) $401.75

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$401.75

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v24.3.11 (2023-10-01 to 2023-12-31) $382.39

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$382.39

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v24.2.12 (2023-07-01 to 2023-09-30) $364.64

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$364.64

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v24.1.13 (2023-04-01 to 2023-06-30) $374.55

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$374.55

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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 (2023-01-01 to 2023-03-31) $373.79

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$373.79

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v23.3.15 (2022-10-01 to 2022-12-31) $363.57

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$363.57

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v23.2.16 (2022-07-01 to 2022-09-30) $347.65

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$347.65

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v23.1.17 (2022-04-01 to 2022-06-30) $337.01

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$337.01

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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 (2022-01-01 to 2022-03-31) $379.90

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$379.90

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v22.3.19 (2021-10-01 to 2021-12-31) $428.22

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$428.22

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v22.2.20 (2021-07-01 to 2021-09-30) $523.22

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$523.22

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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 (2021-04-01 to 2021-06-30) $503.81

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$503.81

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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) $385.61

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$385.61

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v21.3.23 (2020-10-01 to 2020-12-31) $282.64

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$282.64

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v21.2.24 (2020-07-01 to 2020-09-30) $268.43

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$268.43

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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

v21.1.25 (2020-04-01 to 2020-06-30) $263.74

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$263.74

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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 (2020-01-01 to 2020-03-31) $258.74

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$258.74

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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) $248.39

Description

"Triptorelin pamoate"

Core Attributes

Payment Amount

$248.39

Status Indicator? Status indicator assigned to the APC

K

Payment Indicator? Payment indicator assigned to the APC

2

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