N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 329-2.1

Current through Register Vol. 46, No. 53, December 31, 2024

Section 329-2.1 - Scope and Effective Date

(a) Except as set forth in subdivision (b) herein, payment for ambulatory surgery services shall be made according to the ambulatory patient group s (APG) methodology, governing reimbursement for licensed freestanding ambulatory surgical centers and hospital-based ambulatory surgery services as set forth herein and subject to WCB specific adjustments. The effective date of this Subpart shall be October 1, 2015.

(b) The following services performed at licensed freestanding ambulatory surgical centers and hospital-based ambulatory surgery services on or after March 15, 2021 shall not be subject to APG methodology, but shall be reimbursed at the following rates:

CPT	Description	Fee
23472	Arthroplasty Shoulder Total	$7,723.47
23615	FX Proximal Humerus Open TX W/Wo Fixation	$5,869.06
24363	Arthroplasty Elbow Total	$7,723.47
24666	FX Radial Head/Neck Open TX W/Radial Head Prosthetic Replacement	$6,369.06
24685	Olecranon fracture ORIF	$5,869.06
25446	Arthroplasty Wrist Total	$7,723.47
25574	FX Radial and Ulnar Shaft Open TX W/Fixation Radius or Ulna	$5,869.06
25575	FX Radial and Ulnar Shaft Open TX W/Fixation Radius & Ulna	$5,869.06
25607	FX Distal Radial Extra-Articular Open TX W/Internal Fixation	$5,869.06
25608	2 and 3 distal radius fractures	$5,869.06
25609	3 and distal radius fractures	$5,869.06
25825	Arthrodesis Wrist Limited W/Autograft	$4,461.63
27130	Arthroplasty Hip Total	$7,723.47
27132	Conversion Previous Hip SX to Total Hip Replacement	$7,723.47
27447	Arthroplasty Knee Total	$7,723.47
27486	Revise Total Knee Arthroplasty One Component	$7,723.47
27702	Arthroplasty Ankle Total	$7,723.47
27703	Arthroplasty Ankle Revision Total Ankle	$7,723.47
27792	FX Lateral Malleolus (Distal Fibula) Open TX W/Wo Fixation	$5,869.06
27823	Open reduction internal fixation of trimalleolar Fracture	$5,869.06
27870	Ankle Arthrodesis	$5,311.97
28299	Hallux Valgus Correction by Double Osteotomy	$5,449.85
28615	Open reduction of tarsometatarsal dislocations	$5,869.06
28715	Trip Arthrodesis	$4,949.85
28725	Subtalar Arthrodesis	$4,949.85
28730	Tarsometatarsal Arthrodesis	$4,949.85
28740	Tarsometatarsal Arthrodesis	$4,949.85
29827	Arthroscopy Shoulder W/Rotator Cuff Repair	$6,723.47
29888	Arthroscopy Ant Cruciate Ligament Repair/ Augment Reconstruction	$6,677.77

N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 329-2.1

Adopted New York State Register December 30, 2015/Volume XXXVII, Issue 52, eff. 12/30/2015

Amended New York State Register August 4, 2021/Volume XLIII, Issue 31, eff. 8/4/2021