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APCs · CMS data year 2024
Outpatient services by APC
Medicare groups hospital outpatient services into Ambulatory Payment Classifications (APCs): levels of imaging, endoscopy, biopsy, clinic and emergency visits. 64 APCs are summarised here, each with every reporting hospital's average charge and what Medicare allowed.
- 1APCs with a page 64
- 2Most services: avg charge $24,056
- 3…and Medicare allowed $2,634
- 4Most common APC 8011
| APC | Service group | Services | Avg charge | Avg allowed |
|---|---|---|---|---|
| 8011 | Comprehensive Observation Services | 816,376 | $24,056 | $2,634 |
| 5115 | Level 5 Musculoskeletal Procedures | 364,964 | $72,811 | $12,402 |
| 5072 | Level 2 Excision/ Biopsy/ Incision and Drainage | 326,549 | $11,340 | $1,538 |
| 5191 | Level 1 Endovascular Procedures | 285,616 | $28,735 | $3,094 |
| 5491 | Level 1 Intraocular Procedures | 276,244 | $13,353 | $2,208 |
| 5302 | Level 2 Upper GI Procedures | 211,634 | $13,587 | $1,814 |
| 5372 | Level 2 Urology and Related Services | 206,428 | $3,342 | $638 |
| 5373 | Level 3 Urology and Related Services | 184,614 | $13,347 | $1,913 |
| 5183 | Level 3 Vascular Procedures | 176,819 | $21,357 | $3,030 |
| 5361 | Level 1 Laparoscopy and Related Services | 171,539 | $42,414 | $5,494 |
| 5114 | Level 4 Musculoskeletal Procedures | 169,122 | $46,841 | $6,708 |
| 5374 | Level 4 Urology and Related Services | 156,802 | $23,669 | $3,313 |
| 5375 | Level 5 Urology and Related Services | 153,437 | $32,824 | $4,935 |
| 5073 | Level 3 Excision/ Biopsy/ Incision and Drainage | 132,541 | $21,075 | $2,695 |
| 5431 | Level 1 Nerve Procedures | 131,191 | $12,596 | $1,776 |
| 5193 | Level 3 Endovascular Procedures | 123,521 | $78,339 | $10,507 |
| 5213 | Level 3 Electrophysiologic Procedures | 113,395 | $163,578 | $22,752 |
| 5113 | Level 3 Musculoskeletal Procedures | 107,315 | $24,140 | $2,996 |
| 5112 | Level 2 Musculoskeletal Procedures | 79,865 | $12,554 | $1,510 |
| 5116 | Level 6 Musculoskeletal Procedures | 77,366 | $98,060 | $17,397 |
| 5362 | Level 2 Laparoscopy and Related Services | 73,636 | $72,305 | $9,791 |
| 5341 | Level 1 Abdominal/Peritoneal/Biliary and Related Procedures | 72,608 | $27,311 | $3,317 |
| 5223 | Level 3 Pacemaker and Similar Procedures | 65,607 | $60,944 | $10,202 |
| 5182 | Level 2 Vascular Procedures | 64,452 | $10,175 | $1,520 |
| 5192 | Level 2 Endovascular Procedures | 64,329 | $38,597 | $5,460 |
| 5154 | Level 4 Airway Endoscopy | 59,708 | $27,529 | $3,567 |
| 5184 | Level 4 Vascular Procedures | 53,123 | $41,622 | $4,987 |
| 5091 | Level 1 Breast/Lymphatic Surgery and Related Procedures | 51,576 | $27,836 | $3,679 |
| 5092 | Level 2 Breast/Lymphatic Surgery and Related Procedures | 49,643 | $46,718 | $6,254 |
| 5492 | Level 2 Intraocular Procedures | 48,265 | $25,823 | $3,925 |
| 5194 | Level 4 Endovascular Procedures | 46,919 | $111,026 | $16,197 |
| 5153 | Level 3 Airway Endoscopy | 43,789 | $12,727 | $1,595 |
| 5414 | Level 4 Gynecologic Procedures | 41,704 | $21,231 | $3,004 |
| 5155 | Level 5 Airway Endoscopy | 38,424 | $47,790 | $6,501 |
| 5313 | Level 3 Lower GI Procedures | 38,262 | $19,230 | $2,692 |
| 5165 | Level 5 ENT Procedures | 37,605 | $41,209 | $5,580 |
| 5222 | Level 2 Pacemaker and Similar Procedures | 36,360 | $44,464 | $8,090 |
| 5232 | Level 2 ICD and Similar Procedures | 27,623 | $169,956 | $31,054 |
| 5331 | Complex GI Procedures | 24,425 | $35,087 | $5,370 |
| 5303 | Level 3 Upper GI Procedures | 24,416 | $24,790 | $3,638 |
| 5503 | Level 3 Extraocular, Repair, and Plastic Eye Procedures | 24,069 | $16,538 | $2,242 |
| 5376 | Level 6 Urology and Related Services | 22,044 | $54,267 | $8,871 |
| 5465 | Level 5 Neurostimulator and Related Procedures | 21,835 | $139,881 | $28,488 |
| 5415 | Level 5 Gynecologic Procedures | 20,222 | $34,949 | $4,758 |
| 5224 | Level 4 Pacemaker and Similar Procedures | 17,266 | $108,399 | $18,636 |
| 5462 | Level 2 Neurostimulator and Related Procedures | 16,273 | $30,985 | $5,809 |
| 5464 | Level 4 Neurostimulator and Related Procedures | 15,452 | $96,620 | $20,200 |
| 5164 | Level 4 ENT Procedures | 15,436 | $21,440 | $2,864 |
| 5493 | Level 3 Intraocular Procedures | 12,169 | $28,480 | $5,015 |
| 5627 | Level 7 Radiation Therapy | 9,098 | $77,406 | $7,559 |
| 5416 | Level 6 Gynecologic Procedures | 9,029 | $50,045 | $7,264 |
| 5163 | Level 3 ENT Procedures | 8,456 | $9,715 | $1,404 |
| 5378 | Level 8 Urology and Related Services | 7,242 | $100,071 | $18,997 |
| 5212 | Level 2 Electrophysiologic Procedures | 6,691 | $53,665 | $7,095 |
| 5231 | Level 1 ICD and Similar Procedures | 6,336 | $122,086 | $22,388 |
| 5461 | Level 1 Neurostimulator and Related Procedures | 4,870 | $29,582 | $3,137 |
| 5093 | Level 3 Breast/Lymphatic Surgery and Related Procedures | 4,771 | $71,544 | $9,050 |
| 5504 | Level 4 Extraocular, Repair, and Plastic Eye Procedures | 4,404 | $26,666 | $3,723 |
| 5166 | Cochlear Implant Procedure | 4,257 | $140,278 | $31,217 |
| 5094 | Level 4 Breast/Lymphatic Surgery and Related Procedures | 3,138 | $117,441 | $16,978 |
| 5471 | Implantation of Drug Infusion Device | 3,109 | $84,044 | $16,293 |
| 5432 | Level 2 Nerve Procedures | 2,975 | $41,284 | $5,969 |
| 5463 | Level 3 Neurostimulator and Related Procedures | 2,354 | $81,715 | $12,976 |
| 5200 | Implantation Wireless PA Pressure Monitor | 2,288 | $143,929 | $28,212 |
Source: CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024. Checked 2026-10-24.