Medicare Provider Utilization and Payment Data: Outpatient
The data provided here include estimated hospital-specific charges for 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2011. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.
For these APCs, the estimated average charges and the average Medicare payments are provided at the individual hospital level. The actual charges at an individual hospital for an individual service within these APC groups may differ. For a more complete discussion of the claims criteria used in setting the Medicare payment rates for hospital outpatient services, see the Medicare CY 2013 Outpatient Prospective Payment System (OPPS) Claims Accounting document available on the CMS website at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/CMS-1589-FC-Claims-Accounting-narrative.pdf. This estimated outpatient charge data supplements the inpatient charge data available on the CMS Medicare Provider Charge Data Inpatient website (available via the link in the left navigation bar).
Data are being made available in Microsoft Excel (.xlsx) format and comma separated values (.csv) format.
9/4/13 UPDATE: As a result of using the OPPS ratesetting process to develop the summary of outpatient charge and payment data, we inadvertently excluded claims data for visit APCs 0604 (“Level 1 Hospital Clinic Visits”) and 0607 (“Level 4 Hospital Clinic Visits”). The revised outpatient data reflects changes to correct this, with volume increases in the summarized data for APCs 0604 and 0607.
National and State level summaries are also available here:
For answers to any questions about the data, please see our Frequently Asked Questions page.
Inquiries regarding this data can be sent to MedicareProviderData@cms.hhs.gov.
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- Page last Modified: 04/09/2014 1:58 PM
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