Outpatient Charge Data CY 2015
The Outpatient Hospital Utilization and Payment Public Use File (Outpatient Hospital PUF) presents information on comprehensive APC (C-APC) services provided to Medicare fee-for-service beneficiaries. The Outpatient Hospital PUF presents information on the number of APC services, hospitals' average total estimated submitted charges, the average Medicare allowed charges (which includes Medicare regular provider payments and beneficiary cost-sharing payments), the average Medicare regular provider payments, the number of APC services with outlier payments, and the average Medicare outlier provider payments among those services for 25 C-APC Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for calendar year (CY) 2015. 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.
The Provider Outpatient Charge Data and the supplemental summary tables (“National and State Summaries of Outpatient Charge Data”) for CY 2015 have been restructured to reflect summaries for C-APCs which CMS first implemented on January 1, 2015. In prior versions of the Outpatient Hospital PUF, CMS reported summarized utilization and spending metrics for single-APCs where it was relatively easy to attribute total hospital charges for packaged services to a given APC. Given that CMS can attribute all adjunct services on the claim not statutorily excluded from packaging to a C-APC, CMS switched to focusing on C-APC to present a more conceptually cohesive set of services for the Outpatient Hospital PUF. The PUF data for 2011 to 2014 have remained unchanged. Finally, while the national- and state level summary tables include breakdowns by C-APC and the primary HCPCS code for that APC, the suppression rate for the provider-level summary of C-APC/Primary HCPCS codes was too high for CMS to release.
Data are available in two formats:
- An online interactive dataset (allows users to sort and filter data directly without downloading).
- Microsoft Excel download (.xlsx)
Detailed Provider Data:
Interactive Dataset: Provider Outpatient Hospital Charge Data by APC, CY2015, Interactive Dataset
Downloadable Excel: Provider Outpatient Hospital Charge Data by APC, CY2015, Microsoft Excel version
APC Summary Tables:
Interactive Dataset: National Summary of Outpatient Charge Data by APC, CY2015, Interactive Dataset
Interactive Dataset: State Summary of Outpatient Charge Data by APC, CY2015, Interactive Dataset
APC and HCPCS Summary Tables:
Interactive Dataset: National Summary of Outpatient Hospital Charge Data by APC and primary HCPCS, CY2015, Interactive Dataset
Interactive Dataset: State Summary of Outpatient Hospital Charge Data by APC and primary HCPCS, CY2015, Interactive Dataset
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: 02/15/2019 12:03 PM
- Help with File Formats and Plug-Ins