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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 Years (CY) 2011 and 2012.  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).

Outpatient Charge Data CY 2012
Outpatient Charge Data CY 2011

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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