APC 09271

v27.2.0 (2026-07-01 to 2036-06-30) $388.16

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$388.16

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) $386.43

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$386.43

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

v27.0.2 (2026-01-01 to 2026-03-31) $381.36

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$381.36

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) $380.18

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$380.18

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) $374.36

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$374.36

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) $374.02

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$374.02

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) $370.20

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$370.20

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

v25.3.7 (2024-10-01 to 2024-12-31) $369.48

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$369.48

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) $367.84

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$367.84

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

v25.1.9 (2024-04-01 to 2024-06-30) $367.41

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$367.41

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) $366.39

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$366.39

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

v24.3.11 (2023-10-01 to 2023-12-31) $367.18

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$367.18

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) $357.35

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$357.35

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) $357.53

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$357.53

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) $358.90

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$358.90

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

v23.3.15 (2022-10-01 to 2022-12-31) $359.73

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$359.73

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

v23.2.16 (2022-07-01 to 2022-09-30) $359.92

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$359.92

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) $359.80

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$359.80

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) $359.29

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$359.29

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

v22.3.19 (2021-10-01 to 2021-12-31) $357.59

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$357.59

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

v22.2.20 (2021-07-01 to 2021-09-30) $346.46

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$346.46

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) $346.63

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$346.63

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

v22.0.22 (2021-01-01 to 2021-03-31) $346.15

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$346.15

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) $345.78

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$345.78

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) $345.73

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$345.73

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

v21.1.25 (2020-04-01 to 2020-06-30) $345.42

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$345.42

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) $345.52

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$345.52

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) $345.14

Description

"Velaglucerase alfa"

Core Attributes

Payment Amount

$345.14

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