Medicare Provider Utilization and Payment Data: Outpatient
The Outpatient Utilization and Payment Public Use File (Outpatient PUF) presents information on common outpatient services provided to Medicare fee-for-service beneficiaries. The Outpatient PUF presents information on utilization, payment, and estimated hospital-specific charges for select Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Years (CY) 2011 through 2015. 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 2017 Outpatient Prospective Payment System (OPPS) Claims Accounting document available on the CMS website at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/CMS-1656-FC-2017-OPPS-FR-Claims-Accounting.pdf.
Inquiries regarding this data can be sent to MedicareProviderData@cms.hhs.gov.
To receive email notifications, please sign up for the Medicare Provider Data GovDelivery subscription here.
- Page last Modified: 03/01/2018 3:35 PM
- Help with File Formats and Plug-Ins