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References Wu, Z

Once we have determined that a particular code combination of J1 services (or combinations of J1 services reported in conjunction with certain add-on codes) represents a complex version of the primary service because it is sufficiently costly, frequent, and a subset of the primary comprehensive service overall according to the criteria described above, we promote the claim including the complex version of the primary service as described by the code combination to the next higher cost C-APC within the clinical family, unless the primary service is already assigned to the highest cost APC within the C-APC clinical family or assigned to the only C-APC in a clinical family

Mol Med Rep (2017) 16(4):54137

The structure exists because each step informs the next, and skipping a step is the most common reason patients end up on the wrong protocol