ACEP // APC (Ambulatory Payment Classifications) FAQ

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There are hundreds of HCPCS (Healthcare Common Procedure Coding System) codes pertinent to the ED, payable under various APCs. The most common are the Evaluation and Management APCs.

Addendum A.-Final OPPS APCs for CY 2024

APC

CPT

Group Title

SI

Relative Weight

Payment Rate

5021

99281

Level 1 Type A ED Visits

V

0.9691

$84.68

5022

99282

Level 2 Type A ED Visits

V

1.7852

$155.99

5023

99283

Level 3 Type A ED Visits

V

3.1144

$272.14

5024

99284

Level 4 Type A ED Visits

V

4.8344

$422.44

5025

99285

Level 5 Type A ED Visits

V

7.0109

$612.63

5041

99291

Critical Care

S

9.6858

$846.36

5043

G0390

Trauma Activation Code

X

$1305.84

Other common APCs in the ED

APC

HCPCS Code

Short Descriptor

SI

Relative Weight 2023

Payment 2023

5051

12001

Simple repair, 2.5 cm

T

2.1851

$190.94

5052

12031

Intermediate repair 2.5 cm

T

4.3524

$380.32

5051

10060

Drainage of skin abscess

T

2.1851

$190.94

5161

31500

Insert emergency airway

T

2.6662

$232.98

5722

92950

Heart/lung resuscitation CPR

S

3.4260

$299.37

5693

96374

Ther/proph/diag inj iv push

S

2.3395

$204.43

5693

96365

Ther/proph/diag iv inf init

S

2.3395

$204.43

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