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In the CY 2026 OPPS/ASC proposed rule, we proposed to continue to assign CPT code 28740 to APC 5114 (Level 4 Musculoskeletal Procedures) with a status indicator of `J1' (Hospital Part B Services Paid Through a Comprehensive APC

Risk Stratification (CAD Probability) High-risk patients (diabetes, hypertension, smoking history) approved Intermediate risk conditional (documentation-dependent) Low-risk or screening use denied 4

While we recognize that APC geometric mean costs can fluctuate based on a variety of factors, including updated claims and cost report data update, APC level recalibration, and others, the geometric mean costs of both codes suggests that they are appropriately placed in the Level 2 APC based on their estimated resource costs

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We believe requiring a standard identifier will also help CMS, researchers, and innovators reduce dependence on manual processes for identifying the hospital and the hospital locations and increase opportunities for automated processes