Hospital Outpatient

CMS Updates Hospital Outpatient Department Payment Information for Value-Driven Health Care (9-19-12)

The U.S. Department of Health and Human Services is committed to making health care more affordable and accessible.  As part of this effort, the Centers for Medicare & Medicaid Services is making cost and quality data available to all Americans.  As a first step in this initiative, on June 1, 2006, Medicare posted information about the payments it made to hospitals in fiscal year 2005 for common elective procedures and other hospital admissions.  Similar postings of Medicare payment data followed during the year for Ambulatory Surgery Centers, Hospital Outpatient Departments, and Physician Services.  This information is updated annually.

We are now presenting an update to last year's hospital outpatient department information.  The information is being displayed in the same format as last year, updated with calendar year (CY) 2011 data. 

Below you will find eight zipped Microsoft Excel files.  Please note that some of the files are large so printing them is not recommended.  As a reminder, our objective is to provide the basic information for consumers and others to use and analyze at their discretion.  Consumers are encouraged to consult with their physicians if they have questions about the procedures/codes contained in any of the files.  The information is provided in Excel format in order to facilitate its use.  Please take note of the footnotes displayed at the end of each table as the footnotes will be helpful in understanding the data contained in the tables.

The first four hospital outpatient department files (the updated files using CY 2011 data) are as follows:

"Hospital Outpatient Payments for 61 Commonly Performed Procedures" reflects facility costs and services associated with 61 commonly performed procedures.  Service volumes and payment data are broken out nationally, by State, and by county.  Moreover, hospital-specific service volumes are included.

"Other Hospital Outpatient Payments for 23 Commonly Performed Procedures" is a display of additional high utilization procedures in the hospital outpatient setting.   Three new codes were added in for CY 2011 data that were not in effect during CY 2010.

"Hospital Outpatient Payments for Medicare Preventive Services" also contains service volumes and Medicare payment data for preventive services rendered in a hospital outpatient department.

The fourth file is an example of the hospital outpatient data.

The remaining files/documents are the same as those posted last year using CY 2010 data.

Note Regarding Current Procedural Terminology (CPT) Codes Used in the Tables:  CPT only copyright 2011 American Medical Association. All rights reserved. Applicable Federal Acquisition Regulations System (FARS)/Defense Federal Acquisition Regulation Supplement (DFARS) apply.  CPT is a registered trademark of the American Medical Association.