CMAP Addendum B - OPPS Payment Type by Procedure Code Effective October 1, 2022 Procedure Relative Payment Payment Code Short Descriptor SI APC Weight Rate Type CT FEE SCHED Change 0001A Adm sarscov2 30mcg/0.3ml 1st S 09397 0.4752 $40.00 APC-PR 0001F Heart failure composite E1 No 0001U Rbc dna hea 35 ag 11 bld grp A No 0002A Adm sarscov2 30mcg/0.3ml 2nd S 09398 0.4752 $40.00 APC-PR 0002M Liver dis 10 assays w/ash Q4 No 0002U Onc clrct 3 ur metab alg plp Q4 No 0003A Adm sarscov2 30mcg/0.3ml 3rd S 09398 0.4752 $40.00 APC-PR 0003M Liver dis 10 assays w/nash Q4 No 0003U Onc ovar 5 prtn ser alg scor Q4 No 0004A Adm sarscov2 30mcg/0.3ml bst S 09398 0.4752 $40.00 APC-PR 0004M Scoliosis dna alys A No 0005F Osteoarthritis composite E1 No 0005U Onco prst8 3 gene ur alg Q4 No 0006M Onc hep gene risk classifier A No 0007M Onc gastro 51 gene nomogram A No 0007U Rx test prsmv ur w/def conf Q4 No 0008U Hpylori detcj abx rstnc dna A No 0009U Onc brst ca erbb2 amp/nonamp Q4 No 00100 Anesth salivary gland N APC 00102 Anesth repair of cleft lip N APC 00103 Anesth blepharoplasty N APC 00104 Anesth electroshock N APC 0010U Nfct ds strn typ whl gen seq Q4 No 0011A Adm sarscov2 100mcg/0.5ml1st S 09397 0.4752 $40.00 APC-PR 0011M Onc prst8 ca mrna 12 gen alg A No 0011U Rx mntr lc-ms/ms oral fluid Q4 No 00120 Anesth ear surgery N APC 00124 Anesth ear exam N APC 00126 Anesth tympanotomy N APC 0012A Adm sarscov2 100mcg/0.5ml2nd S 09398 0.4752 $40.00 APC-PR 0012F Cap bacterial assess E1 No 0012M Onc mrna 5 gen rsk urthl ca A No 0013A Adm sarscov2 100mcg/0.5ml3rd S 09398 0.4752 $40.00 APC-PR 0013M Onc mrna 5 gen recr urthl ca A No 00140 Anesth procedures on eye N APC 00142 Anesth lens surgery N APC 00144 Anesth corneal transplant N APC 00145 Anesth vitreoretinal surg N APC 00147 Anesth iridectomy N APC 00148 Anesth eye exam N APC 0014A Fee covid-19 vac 2 res E1 No 0014F Comp preop assess cat surg E1 No 0014M Liver ds alys 3 bmrk srm alg Q4 No 0015F Melan follow-up complete E1 No 0015M Adrnl cortcl tum bchm asy 25 Q4 No 00160 Anesth nose/sinus surgery N APC 00162 Anesth nose/sinus surgery N APC 00164 Anesth biopsy of nose N APC 0016M Onc bladder mrna 219 gen alg A No 0016U Onc hmtlmf neo rna bcr/abl1 A No 00170 Anesth procedure on mouth N APC 00172 Anesth cleft palate repair N APC as of 11/23/2022 Page 1 of 334 CMAP Addendum B - OPPS Payment Type by Procedure Code Effective October 1, 2022 Procedure Relative Payment Payment Code Short Descriptor SI APC Weight Rate Type CT FEE SCHED Change 00174 Anesth pharyngeal surgery N APC 00176 Anesth pharyngeal surgery C No 0017M Onc dlbcl mrna 20 genes alg A No 0017U Onc hmtlmf neo jak2 mut dna A No 0018M Trnsplj rnl meas cd154+cll Q4 No 0018U Onc thyr 10 microrna seq alg A No 00190 Anesth face/skull bone surg N APC 00192 Anesth facial bone surgery C No 0019U Onc rna tiss predict alg A No 00210 Anesth cranial surg nos N APC 00211 Anesth cran surg hemotoma C No 00212 Anesth skull drainage N APC 00214 Anesth skull drainage C No 00215 Anesth skull repair/fract C No 00216 Anesth head vessel surgery N APC 00218 Anesth special head surgery N APC 0021A Adm sarscov2 5x1010vp/.5ml 1 E1 No 0021U Onc prst8 detcj 8 autoantb Q4 No 00220 Anesth intrcrn nerve N APC 00222 Anesth head nerve surgery N APC 0022A Adm sarscov2 5x1010vp/.5ml 2 E1 No 0022U Trgt gen seq dna&rna 1-23 gn A No 0023A Fee covid-19 vac 3 booster E1 No 0023U Onc aml dna detcj/nondetcj A No 0024A Fee covid-19 vac 3 res E1 No 0024U Glyca nuc mr spectrsc quan Q4 No 0025U Tenofovir liq chrom ur quan Q4 No 0026U Onc thyr dna&mrna 112 genes A No 0027U Jak2 gene trgt seq alys A No 0029U Rx metab advrs trgt seq alys A No 00300 Anesth head/neck/ptrunk N APC 0030U Rx metab warf trgt seq alys A No 0031A Adm sarscov2 vac ad26 .5ml S 09398 0.4752 $40.00 APC-PR 0031U Cyp1a2 gene A No 00320 Anesth neck organ 1yr/> N APC 00322 Anesth biopsy of thyroid N APC 00326 Anesth larynx/trach < 1 yr N APC 0032A Fee covid-19 vac 4 dose 2 E1 No 0032U Comt gene A No 0033A Fee covid-19 vac 4 booster E1 No 0033U Htr2a htr2c genes A No 0034A Adm sarscov2 vac ad26 .5ml b S 09398 0.4752 $40.00 APC-PR 0034U Tpmt nudt15 genes A No 00350 Anesth neck vessel surgery N APC 00352 Anesth neck vessel surgery N APC 0035U Neuro csf prion prtn qual Q4 No 0036U Xome tum & nml spec seq alys A No 0037U Trgt gen seq dna 324 genes A No 0038U Vitamin d srm microsamp quan Q4 No 0039U Dna antb 2strand hi avidity Q4 No 00400 Anesth skin ext/per/atrunk N APC 00402 Anesth surgery of breast N APC as of 11/23/2022 Page 2 of 334 CMAP Addendum B - OPPS Payment Type by Procedure Code Effective October 1, 2022 Procedure Relative Payment Payment Code Short Descriptor SI APC Weight Rate Type CT FEE SCHED Change 00404 Anesth surgery of breast N APC 00406 Anesth surgery of breast N APC 0040U Bcr/abl1 gene major bp quan A No 00410 Anesth correct heart rhythm N APC 0041A Adm sarscov2 5mcg/0.5ml 1st S 09397 0.4752 $40.00 APC-PR X 0041U B brgdrferi antb 5 prtn igm Q4 No 0042A Adm sarscov2 5mcg/0.5ml 2nd S 09398 0.4752 $40.00 APC-PR X 0042T Ct perfusion w/contrast cbf N No 0042U B brgdrferi antb 12 prtn igg Q4 No 0043A Fee covid-19 vac 5 booster E1 No 0043U Tbrf b grp antb 4 prtn igm Q4 No 0044A Fee covid-19 vac 5 res E1 No 0044U Tbrf b grp antb 4 prtn igg Q4 No 00450 Anesth surgery of shoulder N APC 00454 Anesth collar bone biopsy N APC 0045U Onc brst dux carc is 12 gene A No 0046U Flt3 gene itd variants quan A No 00470 Anesth removal of rib N APC 00472 Anesth chest wall repair N APC 00474 Anesth surgery of rib C No 0047U Onc prst8 mrna 17 gene alg A No 0048U Onc sld org neo dna 468 gene A No 0049U Npm1 gene analysis quan A No 00500 Anesth esophageal surgery N APC 0050U Trgt gen seq dna 194 genes A No 0051A Adm sarscv2 30mcg trs-sucr 1 S 09397 0.4752 $40.00 APC-PR 0051U Rx mntr lc-ms/ms ur/bld 31 Q4 No 00520 Anesth chest procedure N APC 00522 Anesth chest lining biopsy N APC 00524 Anesth chest drainage C No 00528 Anes mediascpy & dx thorscpy N APC 00529 Anes medscpy&thorscpy 1 lung N APC 0052A Adm sarscv2 30mcg trs-sucr 2 S 09398 0.4752 $40.00 APC-PR 0052U Lpoprtn bld w/5 maj classes Q4 No 00530 Anesth pacemaker insertion N APC 00532 Anesth vascular access N APC 00534 Anesth cardioverter/defib N APC 00537 Anesth cardiac electrophys N APC 00539 Anesth trach-bronch reconst N APC 0053A Adm sarscv2 30mcg trs-sucr 3 S 09398 0.4752 $40.00 APC-PR 0053U Onc prst8 ca fish alys 4 gen A No 00540 Anesth chest surgery C No 00541 Anesth one lung ventilation N APC 00542 Anesthesia removal pleura C No 00546 Anesth lung chest wall surg C No 00548 Anesth trachea bronchi surg N APC 0054A Adm sarscv2 30mcg trs-sucr b S 09398 0.4752 $40.00 APC-PR 0054T Bone srgry cmptr fluor image N No 0054U Rx mntr 14+ drugs & sbsts Q4 No 00550 Anesth sternal debridement N APC 0055T Bone srgry cmptr ct/mri imag N No 0055U Card hrt trnspl 96 dna seq A No as of 11/23/2022 Page 3 of 334 CMAP Addendum B - OPPS Payment Type by Procedure Code Effective October 1, 2022 Procedure Relative Payment Payment Code Short Descriptor SI APC Weight Rate Type CT FEE SCHED Change 00560 Anesth heart surg w/o pump C No 00561 Anesth heart surg <1 yr C No 00562 Anesth hrt surg w/pmp age 1+ C No 00563 Anesth heart surg w/arrest N APC 00566 Anesth cabg w/o pump N APC 00567 Anesth cabg w/pump C No 00580 Anesth heart/lung transplnt C No 0058U Onc merkel cll carc srm quan Q4 No 0059U Onc merkel cll carc srm +/- Q4 No 00600 Anesth spine cord surgery N APC 00604 Anesth sitting procedure C No 0060U Twn zyg gen seq alys chrms2 A No 0061A Fee covid-19 vac 7 dose 1 E1 No 0061U Tc meas 5 bmrk sfdi m-s alys Q4 No 00620 Anesth spine cord surgery N APC 00625 Anes spine tranthor w/o vent N APC 00626 Anes spine transthor w/vent N APC 0062A Fee covid-19 vac 7 dose 2 E1 No 0062U Ai sle igg&igm alys 80 bmrk Q4 No 00630 Anesth spine cord surgery N APC 00632 Anesth removal of nerves C No 00635 Anesth lumbar puncture N APC 0063A Fee covid-19 vac 7 booster E1 No 0063U Neuro autism 32 amines alg Q4 No 00640 Anesth spine manipulation N APC 0064A Adm sarscov2 50mcg/0.25mlbst S 09398 0.4752 $40.00 APC-PR 0064U Antb tp total&rpr ia qual Q4 No 0065U Syfls tst nontreponemal antb Q4 No 0066U Pamg-1 ia cervico-vag fluid Q4 No 00670 Anesth spine cord surgery N APC 0067U Onc brst imhchem prfl 4 bmrk A No 0068U Candida species pnl amp prb Q4 No 0069U Onc clrct microrna mir-31-3p A No 00700 Anesth abdominal wall surg N APC 00702 Anesth for liver biopsy N APC 0070U Cyp2d6 gen com&slct rar vrnt A No 0071A Adm sarscv2 10mcg trs-sucr 1 S 09397 0.4752 $40.00 APC-PR 0071T Us leiomyomata ablate <200 J1 05414 31.8325 $2,679.56 No 0071U Cyp2d6 full gene sequence A No 0072A Adm sarscv2 10mcg trs-sucr 2 S 09398 0.4752 $40.00 APC-PR 0072T Us leiomyomata ablate >200 J1 05414 31.8325 $2,679.56 No 0072U Cyp2d6 gen cyp2d6-2d7 hybrid A No 00730 Anesth abdominal wall surg N APC 00731 Anes upr gi ndsc px nos N APC 00732 Anes upr gi ndsc px ercp N APC 0073A Adm sarscv2 10mcg trs-sucr 3 S 09398 0.4752 $40.00 APC-PR 0073U Cyp2d6 gen cyp2d7-2d6 hybrid A No 0074A Adm sarscv2 10mcg trs-sucr b S 09398 0.4752 $40.00 APC-PR X 0074U Cyp2d6 nonduplicated gene A No 00750 Anesth repair of hernia N APC 00752 Anesth repair of hernia N APC 00754 Anesth repair of hernia N APC as of 11/23/2022 Page 4 of 334 CMAP Addendum B - OPPS Payment Type by Procedure Code Effective October 1, 2022 Procedure Relative Payment Payment Code Short Descriptor SI APC Weight Rate Type CT FEE SCHED Change 00756 Anesth repair of hernia N APC 0075T Perq stent/chest vert art C No 0075U Cyp2d6 5' gene dup/mlt A No 0076T S&i stent/chest vert art C No 0076U Cyp2d6 3' gene dup/mlt A No 00770 Anesth blood vessel repair N APC 0077U Ig paraprotein qual bld/ur Q4 No 0078U Pain mgt opi use gnotyp pnl A No 00790 Anesth surg upper abdomen N APC 00792 Anesth hemorr/excise liver C No 00794 Anesth pancreas removal C No 00796 Anesth for liver transplant C No 00797 Anesth surgery for obesity N APC 0079U Cmprtv dna alys mlt snps E1 No 00800 Anesth abdominal wall surg N APC 00802 Anesth fat layer removal N APC 0080U Onc lng 5 clin rsk factr alg A No 00811 Anes lwr intst ndsc nos N APC 00812 Anes lwr intst scr colsc N APC 00813 Anes upr lwr gi ndsc px N APC 0081A Adm sarscv2 3mcg trs-sucr 1 S 09397 0.4752 $40.00 APC-PR X 00820 Anesth abdominal wall surg N APC 0082A Adm sarscv2 3mcg trs-sucr 2 S 09398 0.4752 $40.00 APC-PR X 0082U Rx test def 90+ rx/sbsts ur Q4 No 00830 Anesth repair of hernia N APC 00832 Anesth repair of hernia N APC 00834 Anesth hernia repair < 1 yr N APC 00836 Anesth hernia repair preemie N APC 0083A Adm sarscv2 3mcg trs-sucr 3 S 09398 0.4752 $40.00 APC-PR X 0083U Onc rspse chemo cntrst tomog Q4 No 00840 Anesth surg lower abdomen N APC 00842 Anesth amniocentesis N APC 00844 Anesth pelvis surgery C No 00846 Anesth hysterectomy C No 00848 Anesth pelvic organ surg C No 0084A Fee covid-19 vac 9 res E1 No 0084U Rbc dna gnotyp 10 bld groups A No 00851 Anesth tubal ligation N APC 00860 Anesth surgery of abdomen N APC 00862 Anesth kidney/ureter surg N APC 00864 Anesth removal of bladder C No 00865 Anesth removal of prostate N APC 00866 Anesth removal of adrenal C No 00868 Anesth kidney transplant C No 0086U Nfct ds bact&fng org id 6+ Q4 No 00870 Anesth bladder stone surg N APC 00872 Anesth kidney stone destruct N APC 00873 Anesth kidney stone destruct N APC 0087U Crd hrt trnspl mrna 1283 gen A No 00880 Anesth abdomen vessel surg N APC 00882 Anesth major vein ligation C No 0088U Trnsplj kdn algrft rej 1494 A No as of 11/23/2022 Page 5 of 334 CMAP Addendum B - OPPS Payment Type by Procedure Code Effective October 1, 2022 Procedure Relative Payment Payment Code Short Descriptor SI APC Weight Rate Type CT FEE SCHED Change 0089U Onc mlnma prame & linc00518 Q4 No 00902 Anesth anorectal surgery N APC 00904 Anesth perineal surgery C No 00906 Anesth removal of vulva N APC 00908 Anesth removal of prostate C No 0090U Onc cutan mlnma mrna 23 gene A No 00910 Anesth bladder surgery N APC 00912 Anesth bladder tumor surg N APC 00914 Anesth removal of prostate N APC 00916 Anesth bleeding control N APC 00918 Anesth stone removal N APC 0091A Adm sarscov2 50 mcg/.5 ml1st S 09397 0.4752 $40.00 APC-PR X 0091U Onc clrct scr whl bld alg E1 No 00920 Anesth genitalia surgery N APC 00921 Anesth vasectomy N APC 00922 Anesth sperm duct surgery N APC 00924 Anesth testis exploration N APC 00926 Anesth removal of testis N APC 00928 Anesth removal of testis N APC 0092A Adm sarscov2 50 mcg/.5 ml2nd S 09398 0.4752 $40.00 APC-PR X 0092U Onc lng 3 prtn bmrk plsm alg Q4 No 00930 Anesth testis suspension N APC 00932 Anesth amputation of penis C No 00934 Anesth penis nodes removal C No 00936 Anesth penis nodes removal C No 00938 Anesth insert penis device N APC 0093A Adm sarscov2 50 mcg/.5 ml3rd S 09398 0.4752 $40.00 APC-PR X 0093U Rx mntr 65 com drugs urine Q4 No 00940 Anesth vaginal procedures N APC 00942 Anesth surg on vag/urethral N APC 00944 Anesth vaginal hysterectomy N APC 00948 Anesth repair of cervix N APC 0094A Adm sarscov2 50 mcg/.5 mlbst S 09398 0.4752 $40.00 APC-PR X 0094U Genome rapid sequence alys A No 00950 Anesth vaginal endoscopy N APC 00952 Anesth hysteroscope/graph N APC 0095T Rmvl artific disc addl crvcl C No 0095U Inflm ee elisa alys alg Q4 No 0096U Hpv hi risk types male urine Q4 No 0098T Rev artific disc addl C No 0100T Prosth retina receive&gen E2 No 0101A Fee covid-19 vac 11 dose 1 E1 No 0101T Esw muscskel sys nos J1 05113 34.3595 $2,892.28 No 0101U Hered colon ca do 15 genes A No 0102A Fee covid-19 vac 11 dose 2 E1 No 0102T Esw phy anes lat hmrl epcndl J1 05113 34.3595 $2,892.28 No 0102U Hered brst ca rltd do 17 gen A No 0103A Fee covid-19 vac 11 booster E1 No 0103U Hered ova ca pnl 24 genes A No 0104A Adm sarscov2 5mcg/.5ml as03b E1 No 0105U Neph ckd mult eclia tum nec Q4 No 0106T Touch quant sensory test Q1 05732 0.4107 $34.57 No as of 11/23/2022 Page 6 of 334 CMAP Addendum B - OPPS Payment Type by Procedure Code Effective October 1, 2022 Procedure Relative Payment Payment Code Short Descriptor SI APC Weight Rate Type CT FEE SCHED Change 0106U Gstr emptg 7 timed brth spec Q4 No 0107T Vibrate quant sensory test Q1 05732 0.4107 $34.57 No 0107U C diff tox ag detcj ia stool Q4 No 0108T Cool quant sensory test Q1 05733 0.6754 $56.85 No 0108U Gi barrett esoph 9 prtn bmrk A No 0109T Heat quant sensory test Q1 05732 0.4107 $34.57 No 0109U Id aspergillus dna 4 species Q4 No 0110T Nos quant sensory test Q1 05734 1.3681 $115.16 No 0110U Rx mntr 1+oral onc rx&sbsts Q4 No 01112 Anesth bone aspirate/bx N APC 0111A Adm sarscov2 25mcg/0.25ml1st S 09397 0.4752 $40.00 APC-PR New 0111U Onc colon ca kras&nras alys A No 01120 Anesth pelvis surgery N APC 0112A Adm sarscov2 25mcg/0.25ml2nd S 09398 0.4752 $40.00 APC-PR New 0112U Iadi 16s&18s rrna genes A No 01130 Anesth body cast procedure N APC 0113A Adm sarscov2 25mcg/0.25ml3rd S 09398 0.4752 $40.00 APC-PR New 0113U Onc prst8 pca3&tmprss2-erg A No 01140 Anesth amputation at pelvis C No 0114U Gi barretts esoph vim&ccna1 A No 01150 Anesth pelvic tumor surgery C No 0115U Respir iadna 18 viral&2 bact Q4 No 01160 Anesth pelvis procedure N APC 0116U Rx mntr nzm ia 35+oral flu Q4 No 01170 Anesth pelvis surgery N APC 01173 Anesth fx repair pelvis N APC 0117U Pain mgmt 11 endogenous anal Q4 No 0118U Trnsplj don-drv cll-fr dna A No 0119U Crd ceramides liq chrom plsm Q4 No 01200 Anesth hip joint procedure N APC 01202 Anesth arthroscopy of hip N APC 0120U Onc b cll lymphm mrna 58 gen A No 01210 Anesth hip joint surgery N APC 01212 Anesth hip disarticulation C No 01214 Anesth hip arthroplasty N APC 01215 Anesth revise hip repair N APC 0121U Sc dis vcam-1 whole blood Q4 No 01220 Anesth procedure on femur N APC 0122U Sc dis p-selectin whl blood Q4 No 01230 Anesth surgery of femur N APC 01232 Anesth amputation of femur C No 01234 Anesth radical femur surg C No 0123U Mchnl fragility rbc prflg Q4 No 0124A Adm sarscv2 bvl 30mcg/.3ml b S $40.00 APC-PR New 01250 Anesth upper leg surgery N APC 01260 Anesth upper leg veins surg N APC 01270 Anesth thigh arteries surg N APC 01272 Anesth femoral artery surg C No 01274 Anesth femoral embolectomy C No 0129U Hered brst ca rltd do panel A No 0130U Hered colon ca do mrna pnl A No 0131U Hered brst ca rltd do pnl 13 A No as of 11/23/2022 Page 7 of 334 CMAP Addendum B - OPPS Payment Type by Procedure Code Effective October 1, 2022 Procedure Relative Payment Payment Code Short Descriptor SI APC Weight Rate Type CT FEE SCHED Change 01320 Anesth knee area surgery N APC 0132U Hered ova ca rltd do pnl 17 A No 0133U Hered prst8 ca rltd do 11 A No 0134A Adm sarscv2 bvl 50mcg/.5ml b S $40.00 APC-PR New 01340 Anesth knee area procedure N APC 0134U Hered pan ca mrna pnl 18 gen A No 0135U Hered gyn ca mrna pnl 12 gen A No 01360 Anesth knee area surgery N APC 0136U Atm mrna seq alys A No 0137U Palb2 mrna seq alys A No 01380 Anesth knee joint procedure N APC 01382 Anesth dx knee arthroscopy N APC 0138U Brca1 brca2 mrna seq alys A No 01390 Anesth knee area procedure N APC 01392 Anesth knee area surgery N APC 01400 Anesth knee joint surgery N APC 01402 Anesth knee arthroplasty N APC 01404 Anesth amputation at knee C No 0140U Nfct ds fungi dna 15 trgt Q4 No 0141U Nfct ds bact&fng gram pos Q4 No 01420 Anesth knee joint casting N APC 0142U Nfct ds bact&fng gram neg Q4 No 01430 Anesth knee veins surgery N APC 01432 Anesth knee vessel surg N APC 0143U Drug assay 120+ rx/metablt Q4 No 01440 Anesth knee arteries surg N APC 01442 Anesth knee artery surg C No 01444 Anesth knee artery repair C No 0144A Adm sarscv2 bvl 25mcg/.25ml b S $40.00 APC-PR New 0144U Drug assay 160+ rx/metablt Q4 No 0145U Drug assay 65+ rx/metablt Q4 No 01462 Anesth lower leg procedure N APC 01464 Anesth ankle/ft arthroscopy N APC 0146U Drug assay 80+ rx/metablt Q4 No 01470 Anesth lower leg surgery N APC 01472 Anesth achilles tendon surg N APC 01474 Anesth lower leg surgery N APC 0147U Drug assay 85+ rx/metablt Q4 No 01480 Anesth lower leg bone surg N APC 01482 Anesth radical leg surgery N APC 01484 Anesth lower leg revision N APC 01486 Anesth ankle replacement N APC 0148U Drug assay 100+ rx/metablt Q4 No 01490 Anesth lower leg casting N APC 0149U Drug assay 60+ rx/metablt Q4 No 01500 Anesth leg arteries surg N APC 01502 Anesth lwr leg embolectomy C No 0150U Drug assay 120+ rx/metablt Q4 No 01520 Anesth lower leg vein surg N APC 01522 Anesth lower leg vein surg N APC 0152U Nfct ds dna untrgt ngnrj seq Q4 No 0153U Onc breast mrna 101 genes A No as of 11/23/2022 Page 8 of 334 CMAP Addendum B - OPPS Payment Type by Procedure Code Effective October 1, 2022 Procedure Relative Payment Payment Code Short Descriptor SI APC Weight Rate Type CT FEE SCHED Change 0154A Adm sarscv2 bvl 10mcg/.2ml b S $40.00 APC-PR New 0154U Onc urthl ca rna fgfr3 gene A No 0155U Onc brst ca dna pik3ca gene A No 0156U Copy number sequence alys A No 0157U Apc mrna seq alys A No 0158U Mlh1 mrna seq alys A No 0159U Msh2 mrna seq alys A No 0160U Msh6 mrna seq alys A No 01610 Anesth surgery of shoulder N APC 0161U Pms2 mrna seq alys A No 01620 Anesth shoulder procedure N APC 01622 Anes dx shoulder arthroscopy N APC 0162U Hered colon ca trgt mrna pnl A No 01630 Anesth surgery of shoulder N APC 01634 Anesth shoulder joint amput C No 01636 Anesth forequarter amput C No 01638 Anesth shoulder replacement N APC 0163T Tot disc arthrp ea addl lmbr C No 0163U Onc clrct scr 3 prtn alg E1 No 0164T Remove lumb artif disc addl C No 0164U Gi ibs ia anti-cdtb&vinculin Q4 No 01650 Anesth shoulder artery surg N APC 01652 Anesth shoulder vessel surg C No 01654 Anesth shoulder vessel surg C No 01656 Anesth arm-leg vessel surg C No 0165T Revise lumb artif disc addl C No 0165U Peanut allg asmt epi Q4 No 0166U Liver ds 10 biochem asy srm Q4 No 01670 Anesth shoulder vein surg N APC 0167U Chornc gonadotropin hcg ia Q4 No 01680 Anesth shoulder casting N APC 0169U Nudt15&tpmt gene com vrnt A No 0170U Neuro asd rna next gen seq A No 01710 Anesth elbow area surgery N APC 01712 Anesth uppr arm tendon surg N APC 01714 Anesth uppr arm tendon surg N APC 01716 Anesth biceps tendon repair N APC 0171U Trgt gen seq alys pnl dna 23 A No 0172U Onc sld tum alys brca1 brca2 A No 01730 Anesth uppr arm procedure N APC 01732 Anesth dx elbow arthroscopy N APC 0173U Psyc gen alys panel 14 genes A No 01740 Anesth upper arm surgery N APC 01742 Anesth humerus surgery N APC 01744 Anesth humerus repair N APC 0174T Cad cxr with interp N No 0174U Onc solid tumor 30 prtn trgt Q4 No 01756 Anesth radical humerus surg C No 01758 Anesth humeral lesion surg N APC 0175T Cad cxr remote N No 0175U Psyc gen alys panel 15 genes A No 01760 Anesth elbow replacement N APC as of 11/23/2022 Page 9 of 334 CMAP Addendum B - OPPS Payment Type by Procedure Code Effective October 1, 2022 Procedure Relative Payment Payment Code Short Descriptor SI APC Weight Rate Type CT FEE SCHED Change 0176U Cdtb&vinculin igg antb ia Q4 No 01770 Anesth uppr arm artery surg N APC 01772 Anesth uppr arm embolectomy N APC 0177U Onc brst ca dna pik3ca 11 A No 01780 Anesth upper arm vein surg N APC 01782 Anesth uppr arm vein repair N APC 0178U Peanut allg asmt epi clin rx Q4 No 0179U Onc nonsm cll lng ca alys 23 A No 0180U Abo gnotyp abo 7 exons A No 01810 Anesth lower arm surgery N APC 0181U Co gnotyp aqp1 exon 1 A No 01820 Anesth lower arm procedure N APC 01829 Anesth dx wrist arthroscopy N APC 0182U Crom gnotyp cd55 exons 1-10 A No 01830 Anesth lower arm surgery N APC 01832 Anesth wrist replacement N APC 0183U Di gnotyp slc4a1 exon 19 A No 01840 Anesth lwr arm artery surg N APC 01842 Anesth lwr arm embolectomy N APC 01844 Anesth vascular shunt surg N APC 0184T Exc rectal tumor endoscopic J1 05331 61.0719 $5,140.85 No 0184U Do gnotyp art4 exon 2 A No 01850 Anesth lower arm vein surg N APC 01852 Anesth lwr arm vein repair N APC 0185U Fut1 gnotyp fut1 exon 4 A No 01860 Anesth lower arm casting N APC 0186U Fut2 gnotyp fut2 exon 2 A No 0187U Fy gnotyp ackr1 exons 1-2 A No 0188U Ge gnotyp gypc exons 1-4 A No 0189U Gypa gnotyp ntrns 1 5 exon 2 A No 0190U Gypb gnotyp ntrns 1 5 seux 3 A No 01916 Anesth dx arteriography N APC 0191U In gnotyp cd44 exons 2 3 6 A No 01920 Anesth catheterize heart N APC 01922 Anesth cat or mri scan N APC 01924 Anes ther interven rad artrl N APC 01925 Anes ther interven rad card N APC 01926 Anes tx interv rad hrt/cran N APC 0192U Jk gnotyp slc14a1 exon 9 A No 01930 Anes ther interven rad vein N APC 01931 Anes ther interven rad tips N APC 01932 Anes tx interv rad th vein N APC 01933 Anes tx interv rad cran vein N APC 01937 Anes drg/aspir crv/thrc N APC 01938 Anes drg/aspir lmbr/sac N APC 01939 Anes nulyt agt crv/thrc N APC 0193U Jr gnotyp abcg2 exons 2-26 A No 01940 Anes nulyt agt lmbr/sac N APC 01941 Anes neuromd/ntrvrt crv/thrc N APC 01942 Anes neuromd/ntrvrt lmbr/sac N APC 0194U Kel gnotyp kel exon 8 A No 01951 Anesth burn less 4 percent N APC as of 11/23/2022 Page 10 of 334