Comprehensive APCs, Medicare's outpatient payment groups: submitted charge against what Medicare allowed, per service.
APC
Service
Services
Charge
Allowed
Billed ÷ allowed
8011
Comprehensive Observation Services
150
$32,894
$2,281
14.4×
5362
Level 2 Laparoscopy and Related Services
137
$64,742
$8,629
7.5×
5191
Level 1 Endovascular Procedures
130
$33,133
$2,738
12.1×
5361
Level 1 Laparoscopy and Related Services
96
$40,421
$4,813
8.4×
5375
Level 5 Urology and Related Services
93
$44,163
$4,303
10.3×
5072
Level 2 Excision/ Biopsy/ Incision and Drainage
78
$12,563
$1,340
9.4×
5374
Level 4 Urology and Related Services
71
$32,912
$2,885
11.4×
5114
Level 4 Musculoskeletal Procedures
57
$60,804
$5,950
10.2×
5113
Level 3 Musculoskeletal Procedures
51
$32,807
$2,568
12.8×
5373
Level 3 Urology and Related Services
46
$25,760
$1,718
15.0×
5193
Level 3 Endovascular Procedures
46
$142,533
$9,274
15.4×
5092
Level 2 Breast/Lymphatic Surgery and Related Procedures
44
$48,693
$5,301
9.2×
5492
Level 2 Intraocular Procedures
44
$25,856
$3,370
7.7×
5183
Level 3 Vascular Procedures
40
$37,808
$2,635
14.3×
5153
Level 3 Airway Endoscopy
38
$19,623
$1,312
15.0×
5154
Level 4 Airway Endoscopy
38
$31,168
$3,093
10.1×
5464
Level 4 Neurostimulator and Related Procedures
36
$153,200
$17,943
8.5×
5302
Level 2 Upper GI Procedures
35
$14,318
$1,605
8.9×
5414
Level 4 Gynecologic Procedures
33
$29,151
$2,637
11.1×
5155
Level 5 Airway Endoscopy
32
$39,227
$5,629
7.0×
5465
Level 5 Neurostimulator and Related Procedures
32
$199,556
$25,353
7.9×
5165
Level 5 ENT Procedures
30
$43,987
$4,940
8.9×
5376
Level 6 Urology and Related Services
29
$55,174
$7,771
7.1×
5115
Level 5 Musculoskeletal Procedures
29
$109,473
$11,089
9.9×
5462
Level 2 Neurostimulator and Related Procedures
23
$39,281
$5,067
7.8×
5503
Level 3 Extraocular, Repair, and Plastic Eye Procedures
22
$26,747
$1,971
13.6×
5192
Level 2 Endovascular Procedures
20
$70,275
$4,821
14.6×
5091
Level 1 Breast/Lymphatic Surgery and Related Procedures
19
$26,765
$3,215
8.3×
5184
Level 4 Vascular Procedures
19
$46,112
$4,635
9.9×
5223
Level 3 Pacemaker and Similar Procedures
17
$165,859
$9,003
18.4×
5415
Level 5 Gynecologic Procedures
17
$43,232
$4,196
10.3×
5431
Level 1 Nerve Procedures
15
$15,983
$1,542
10.4×
5341
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures
15
$37,860
$2,918
13.0×
5232
Level 2 ICD and Similar Procedures
13
$271,788
$27,670
9.8×
5194
Level 4 Endovascular Procedures
13
$222,683
$14,763
15.1×
5112
Level 2 Musculoskeletal Procedures
12
$14,772
$1,356
10.9×
5164
Level 4 ENT Procedures
12
$30,646
$2,535
12.1×
5182
Level 2 Vascular Procedures
11
$8,898
$1,351
6.6×
5471
Implantation of Drug Infusion Device
—
—
—
—
5416
Level 6 Gynecologic Procedures
—
—
—
—
5493
Level 3 Intraocular Procedures
—
—
—
—
5504
Level 4 Extraocular, Repair, and Plastic Eye Procedures
—
—
—
—
5463
Level 3 Neurostimulator and Related Procedures
—
—
—
—
5461
Level 1 Neurostimulator and Related Procedures
—
—
—
—
5073
Level 3 Excision/ Biopsy/ Incision and Drainage
—
—
—
—
5378
Level 8 Urology and Related Services
—
—
—
—
5212
Level 2 Electrophysiologic Procedures
—
—
—
—
5222
Level 2 Pacemaker and Similar Procedures
—
—
—
—
5166
Cochlear Implant Procedure
—
—
—
—
5231
Level 1 ICD and Similar Procedures
—
—
—
—
5116
Level 6 Musculoskeletal Procedures
—
—
—
—
5303
Level 3 Upper GI Procedures
—
—
—
—
5313
Level 3 Lower GI Procedures
—
—
—
—
5372
Level 2 Urology and Related Services
—
—
—
—
5331
Complex GI Procedures
—
—
—
—
5094
Level 4 Breast/Lymphatic Surgery and Related Procedures
—
—
—
—
5093
Level 3 Breast/Lymphatic Surgery and Related Procedures
—
—
—
—
5377
Level 7 Urology and Related Services
—
—
—
—
5163
Level 3 ENT Procedures
—
—
—
—