      *********************************************
      *    01/21/2020 RELEASE - V202013           *
      *               PRODUCTION                  *
      *********************************************
NOTE TO: Shared System Coordinators, MEDICARE Coordinators

SUBJECT: Outpatient Prospective Payment System (OPPS) Pricer System
         Release, Version 202013
(December 20, 2019)  --ACTION--refer to CMS change request CR #11605

This OPPS Pricer release is the updated version and is designed for
implementation in conjunction with the January 2020 OCE/APC V21.0.
Version 2020.1.2, which was released on 12/20/2019, should continue
to be used in conjunction with the new OPPSWI19 member in this
version.

************************* IMPORTANT NOTE ***************************
FISS will compile OPPSCAL internally as OPPSWI19 copybook is too large
to compile within CMS mainframe. FISS will test OPPSCAL using new
OPPSWI19 copybook and communicate findings with CMS.
In the event FISS is unable to compile the new OPPSWI19 copybook,
CMS will re-release OPPSCAL pricer with the removal of CY 2013 logic
to provide memory capacity to incoporate new OPPSWI19 copybook.
************************* IMPORTANT NOTE ***************************


Version 2020.1.3 includes the following updates in OPPSCAL:
-----------------------------------------------------------------
 - Updated OPPSWI19 with the following provider types:
         -  OPPS hospitals not in IPPS
         -  IPPS hospitals
         -  CMHCs
         -  CORFs
         -  Home Health
         -  Hospice
         -  Unit types (where there is a letter in the 3rd digit)
 - OPPSWI19 now has a total of 11,372 provider entries
 - Updated APC 5594's rate in accordance with the Further Consolidated
   Appropriations Act of 2020 (FCAA)
         -BASEAPCS
         -OPPSAPCS

Version 2020.1.2 includes the following updates in OPPSCAL:
-----------------------------------------------------------------
 - Added 3483 IPPS previous wage index records to OPPSWI19

Version 2020.1.1 includes the following updates in OPPSCAL:
-----------------------------------------------------------------
 - Renamed copybook 'PREV200' to 'OPPSWI19' per FISS request
   on 12/11/2019.


Version 2020.1.0 includes the following updates in OPPSCAL:
-----------------------------------------------------------------
 - CREATE VERSION 2020.1.0 (JANUARY 2019 PROD)
 - REMOVED CY 2011 & 2012, PRICER ONLY STORES 7 YEARS
   PRICER NOW CALCULATES FOR CY 2013 - 2020
 - UPDATED W-STORAGE-REF
 - CREATE NEW CAL-VERSION19
 - CHANGE QUALITY REDUCTION FROM 0.980 TO 0.981
 - CHANGED THE OUTLIER THRESHOLD FROM 4825 to 5075
 - CHANGED THE INPATIENT DEDUCTIBLE CAP(H-IP-LIMIT) FROM 1364 TO 1408
 - ADD PMF ='X' TO VALID LIST OF PYMT METHOD FLAG, TREATED AS
   PMF ='7' UPDATED LOGIC
 - ADD PMF ='Y' TO VALID LIST OF PYMT METHOD FLAG, TREATED AS
   PMF ='8' UPDATED LOGIC
 - ADD PMF ='Z' TO VALID LIST OF PYMT METHOD FLAG, TREATED AS
   FLAG, TREATED AS PMF ='0' UPDATED LOGIC
 - QUALITY ADJUSTMENT EXCLUSION FOR NEW TECHNOLOGY CATEGORY APC RANGES:
               - 1575-1599 (EFF. 1/1/2016)
               - 1901-1906 (EFF. 1/1/2017)
               - 1907-1908 (EFF. 1/1/2018)
 - UPDATED LOGIC TO PERFORM LOOKUP OF PROVIDERS RURAL FLOOR IN THIRD
    COLUMN OF WAGE INDEX TABLE
 - CREATE NEW SECTION:
               - 19000-PROCESS-MAIN-NEW
               - 19900-END-PRICE-RTN-EXIT
 - CREATE NEW PARAGRAPHS:
               - 19121-WI-QUARTILE-ADJ
               - 19121-WI-QUARTILE-ADJ-EXIT
               - 19122-WI-TRANSITION-ADJ
               - 19122-WI-TRANSITION-ADJ-EXIT
               - 19123-GET-PRIOR-CY-WI
               - 19123-GET-PRIOR-CY-WI-EXIT
 - NEW VARIABLES:
               - PMF-A-REDUCT-2020
               - WI-QUARTILE-CY2020
               - WI-PCT-REDUCT-CY2020
               - WI-PCT-ADJ-CY2020
               - H-PREV-WINX
 - UPDATED VARIABLES:
               - OUTM-IDX        PIC 9(04)
 - NEW COPYBOOKS:
               - OPPSWI19
 - UPDATED TABLES & COPYBOOKS:
               - BASEWNXC -ADDED THIRD COLUMN RURAL WI
               - BASEWNXF -BASEWNXC WITH TWO COLUMNS FOR FISS
               - OPPSWNXC -ADDED THIRD COLUMN RURAL WI
               - OPPSOUTM
 - RETRO - CREATED W-2019-BLOOD-APC-TABLE TO HOLD THE 2019 LIST
           OF BLOOD DEDUCTIBLE HCPCS
         - CREATED W-2020-BLOOD-APC-TABLE TO HOLD THE 2020 LIST
           OF BLOOD DEDUCTIBLE HCPCS
 - REMOVED COPYBOOKS:
               - PHP-INDX10
               - MH-INDX10
               - MH-INDX12
               - DEV-INDX11
               - DEV-INDX12
               - W11BD-INDX
               - W12BD-INDX
 - Updated this README and the MANIFEST members for this release.

A partitioned data set (PDS) of the code
(MU00.@BF12390.OPPS.V202013.COBOL) is at the CMS Data Center for users
to obtain by Connect:Direct (Network DataMover).

The 28 members listed below comprise the Pricer, but only the modules
that changed since the previous release are included in the PDS.

1  source program - OPPSCAL.

16 copybooks  - --------,OPPSWNXC,OPPSAPCS,--------,--------,--------,
                --------,--------,--------,--------,--------,--------,
                --------,OPPSPTRH,OPPSPTRO,OPPSPTCH,OPPSPTCO,--------,
                --------,--------,--------,--------,OPPSPTDO,--------,
                --------,--------,DEVRED13,OPPSMH13,OPPSPH13,DEVCR14 ,
                OPPSMH14,OPPSPH14,DEVCR15 ,--------,OPPSOUTM,OPPSWI19.

8  databooks  - BASEAPCS,--------,BASEWNXC,BASEWNXF,BASEPTRH,BASEPTRO,
                BASEPTCH,BASEPTCO,BASEPTDO.

3  text files - copy of this Release Memorandum, the manifest,
                and a list of the return codes (expanded by user notes)
              - README,RTNCODES,MANIFEST.


If you have any questions concerning this release or any other OPPS
Pricer-related issues, please call Fred Rooke at (404) 562-7205.





                              Gabriel Farmer
                              Computer Specialist/Systems Analyst
                              Division of Data Systems
                              CMS/CMM/PBG/DDS



                              Page 1 of 2
OPPS Pricer Release Notes:

Below are brief descriptions of the OPPS Pricer modules to be used for
the system plus a copy of the Linkage Section and the CALL statement
needed to access the module.  This list includes all members that have
been associated with the OPPS Pricer software (including those no
longer used).

BASEAPCS - human-readable data from which the OPPSAPCS copybook is built

BASEPTCH - human-readable data from which the OPPSPTCH copybook is built

BASEPTCO - human-readable data from which the OPPSPTCO copybook is built

BASEPTDO - human-readable data from which the OPPSPTDO copybook is built

BASEPTRH - human-readable data from which the OPPSPTRH copybook is built

BASEPTRO - human-readable data from which the OPPSPTRO copybook is built

BASEWINX - human-readable data from which the OPPSWINX copybook is built

BASEWNXC - human-readable data from which the OPPSWNXC copybook is built

BASEWNXF - basewnxc with only two  wage index columns for FISS.

DEVRED07 - copybook of 2007 device reduction APCs and reduction amounts

DEVRED08 - copybook of 2008 device reduction APCs and reduction amounts

DEVRED09 - copybook of 2009 device reduction APCs and reduction amounts

DEVRED10 - copybook of 2010 device reduction APCs and reduction amounts

DEVRED11 - copybook of 2011 device reduction APCs and reduction amounts

DEVRED12 - copybook of 2012 device reduction APCs and reduction amounts

DEVRED13 - copybook of 2013 device reduction APCs and reduction amounts

DEVCR14  - copybook of 2014 device credit eligible apcs and credit caps

DEVCR15  - copybook of 2015 device credit eligible apcs and credit caps

OPPSAPCS - copybook of APC groups for OPPSCAL,
           expanded to include additional APC groups
OPPSCAL  - source code for OPPS pricing subroutine

OPPSMH08 - copybook of CY 2008 mental health HCPCS

OPPSMH09 - copybook of CY 2009 mental health HCPCS

OPPSMH10 - copybook of CY 2010 mental health HCPCS

OPPSMH12 - copybook of CY 2012 mental health HCPCS

OPPSMH13 - copybook of CY 2013 mental health HCPCS

OPPSMH14 - copybook of CY 2014 mental health HCPCS

OPPSOF02 - copybook of device APC groups with an offset amount,
           for SI ' H' processing for OPPSCAL for 2002
OPPSOF03 - copybook of device APC groups with an offset amount,
           for SI ' H' processing for OPPSCAL for 2003
OPPSOF04 - copybook of device APC groups with an offset amount,
           for SI ' H' processing for OPPSCAL for 2004, 2005
OPPSOF06 - copybook of device APC groups with an offset amount,
           for SI ' H' processing for OPPSCAL for 2006
OPPSOF07 - copybook of device APC groups with an offset amount,
           for SI ' H' processing for OPPSCAL for 2007
OPPSOF08 - copybook of device APC groups with an offset amount,
           for SI ' H' processing for OPPSCAL for 2008
OPPSOUTM - copybook of outmigration adjustments by FIPS
           county code
OPPSPH08 - copybook of CY 2008 partial hospitalization HCPCS

OPPSPH09 - copybook of CY 2009 partial hospitalization HCPCS

OPPSPH10 - copybook of CY 2010 - 2012 partial hospitalization HCPCS

OPPSPH13 - copybook of CY 2013 partial hospitalization HCPCS

OPPSPH14 - copybook of CY 2014 partial hospitalization HCPCS

OPPSPTCH - copybook of pass-through contrast agent hcpcs for OPPSCAL

OPPSPTCO - copybook of pass-through contrast agent offsets for OPPSCAL

OPPSPTDO - copybook of pass-through device offsets for OPPSCAL

OPPSPTRH - copybook of pass-through radiopharm. hcpcs for OPPSCAL

OPPSPTRO - copybook of pass-through radiopharm. offsets for OPPSCAL

OPPSWINX - copybook of wage indices by MSA for OPPSCAL

OPPSWNXC - copybook of wage indices by CBSA for OPPSCAL

OPPSWI19 - copybook of previous CY wage indices for OPPSCAL (2019)

RTNCODES - list of OPPS Pricer claim and line level return codes

SSRFBN09 - copybook of CY 2009 state-specific rural floor budget
           neutrality (SSRFBN) factors
SSRFBN10 - copybook of CY 2010 state-specific rural floor budget
           neutrality (SSRFBN) factors: 01/01/2010 - 06/30/2010
SSRFB10B - copybook of CY 2010 state-specific rural floor budget
           neutrality (SSRFBN) factors: 07/01/2010 - 12/31/2010
README   - copy of this memorandum

MANIFEST - listing of the included and excluded members

This is the LINKAGE SECTION defined in OPPSCAL.



      ***************************************************************   00000100
      *   WHEN FISS CALLS THIS PROGRAM, THEY GET THE LINKAGE        *   00000300
      *   SECTION.                                                  *   00000400
      ***************************************************************   00000600

      ***************************************************************
      * LAYUP TABLE AREA FOR OUTPATIENT PROVIDER SPECIFIC RECORD    *
      ***************************************************************

       01  L-PROV-SPEC-AREA.
               05  L-PSF-NPI                    PIC X(08).
               05  L-PSF-NPI-FILLER             PIC X(02).
               05  L-PSF-PROV-OSCAR.
                 10  L-PSF-PROV-ST              PIC X(02).
                 10  L-PSF-PROV-3456            PIC X(04).
               05  L-PSF-EFFDT                  PIC 9(08).
               05  L-PSF-FY-BEGIN-DT            PIC 9(08).
               05  L-PSF-REPORT-DT              PIC 9(08).
               05  L-PSF-TERMDT                 PIC 9(08).
               05  L-PSF-WAIVE-IND              PIC X(01).
               05  L-PSF-FI-NUM                 PIC 9(05).
               05  L-PSF-PROV-TYPE              PIC X(02).
               05  L-PSF-SPCL-LOCATION-IND      PIC X(01).
               05  L-PSF-WGIDX-RECLASS          PIC X(01).
               05  L-PSF-GEO-MSA                PIC X(04).
               05  L-PSF-WI-MSA                 PIC X(04).
               05  L-PSF-COLA                   PIC 9V9(03).
               05  L-PSF-STATE-CODE             PIC 9(02).
               05  L-PSF-TOPS-INDICATOR         PIC X(01).
               05  L-PSF-HOSP-QUAL-IND          PIC X(01).
               05  FILLER                       PIC X(01).
               05  L-PSF-OPCOST-RATIO           PIC 9V9(03).
               05  L-PSF-GEO-CBSA               PIC X(05).
               05  L-PSF-WI-CBSA                PIC X(05).
               05  L-PSF-SPEC-WGIDX             PIC 9(02)V9(04).
               05  L-PSF-SPEC-PYMT-IND          PIC X(01).
               05  L-PSF-APC-LINE-CNT           PIC 9(04).
               05  L-PSF-ESRD-CHILD-QUAL-IND    PIC X(01).
               05  L-PSF-DEVICE-CCR             PIC 9V9(03).
               05  L-PSF-CARRIER-LOCAL          PIC X(7).
               05  L-PSF-COUNTY-CODE            PIC 9(5).
               05  L-PSF-PYMT-CBSA              PIC X(5).
               05  L-PSF-PYMT-MODEL-ADJ         PIC 9V9(05).
               05  FILLER                       PIC X(34).
               05  L-PSF-APC-TABLE     OCCURS 999 TIMES
                        DEPENDING ON L-PSF-APC-LINE-CNT.
                   10  L-PSF-APC                PIC X(04).
                   10  L-PSF-RED-COIN           PIC 9(04)V99.


      ***************************************************************   00000100
      *  INPUT RECORD FROM THE OCE/STANDARD SYSTEM                  *
      *-------------------------------------------------------------*
      * BELOW ARE THE VARIABLES THAT WILL BE PASSED                 *
      * TO PRICER FROM THE OCE BEGINNING OCT. 1, 2005 THERE WILL BE *
      *    - INCREASED SIZE OF SERVICE AND PAYMENT - 1 TO 2 BYTES   *
      *    - INCREASED SIZE OF PYMT ADJUSTMENT FLAG - 1 TO 2 BYTES  *
      *    CY 2009 EDITS - MADE 11/10/2008:                         *
      *    - INCREASED SIZE OF SERVICE UNITS - 7 TO 9 BYTES         *
      *    - ADDED COMPOSITE ADJUSTMENT FLAG - 2 BYTES              *
      ***************************************************************
       01  OPPS-LINE-CNT                  PIC 9(08) COMP.
       01  OCE-DATA.
           05  OPPS-OCE-LINE OCCURS 450 TIMES
                     DEPENDING ON OPPS-LINE-CNT.
               10  OPPS-HCPCS.
                 15  OPPS-ALPHA           PIC X(01).
                 15  FILLER               PIC X(04).
               10  OPPS-GRP.
                 15  FILLER               PIC X(01).
                 15  OPPS-APC             PIC X(04).
               10  OPPS-HCPCS-APC         PIC X(05).
               10  OPPS-SRVC-IND          PIC X(02).
               10  OPPS-PYMT-IND          PIC X(02).
               10  OPPS-DISC-FACT         PIC 9(01).
               10  OPPS-LITEM-DR-FLAG     PIC X(01).
               10  OPPS-PKG-FLAG          PIC X(01).
               10  OPPS-PYMT-ADJ-FLAG     PIC X(02).
               10  OPPS-SITE-SRVC-FLAG    PIC X(01).
               10  OPPS-SRVC-UNITS        PIC 9(09).
               10  OPPS-SUB-CHRG          PIC 9(08)V99.
               10  OPPS-LITEM-ACT-FLAG    PIC X(01).
               10  OPPS-COMP-ADJ-FLAG     PIC X(02).
       01  L-SERVICE-FROM-DATE       PIC 9(08).
       01  BENE-DEDUCT               PIC 9(03)V9(02).
       01  BENE-BLOOD-PINTS          PIC 9(01).


      ***************************************************************
      *   BELOW ARE THE VARIABLES THAT WILL BE PASSED BACK          *
      *   TO SS ASSOCIATED WITH THE BILL BEING PROCESSED            *
      *   - EFF. 04/01/2002 CALCULATE LINE ITEM OUTIER PAYMENT      *
      ***************************************************************
       01  A-ADDITIONAL-VARIABLES.
           05  A-CALC-VERS             PIC X(07).
           05  A-TOTAL-CLM-DEDUCT      PIC 9(03)V9(02).
           05  A-OUTLIER-PYMT          PIC 9(07)V9(02).
           05  A-TOT-CLM-PYMT          PIC 9(07)V9(02).
           05  A-TOT-CLM-CHRG          PIC 9(07)V9(02).
           05  A-CLM-RTN-CODE          PIC 9(02).
           05  A-MSA                   PIC X(04).
           05  A-CBSA                  PIC X(05).
           05  A-WINX                  PIC S9V9(04).
           05  A-BLOOD-PINTS-USED      PIC 9(01).
           05  A-BLOOD-DEDUCT-DUE      PIC 9(05)V9(02).
           05  A-DEVICE-CREDIT-QD      PIC 9(07)V9(02).
           05  A-LINE-ITEMS OCCURS 450 TIMES
                   DEPENDING ON OPPS-LINE-CNT.
             10  A-LITEM-PYMT          PIC 9(07)V9(02).
             10  A-LITEM-REIM          PIC 9(07)V9(02).
             10  A-TOTAL-LN-DEDUCT     PIC 9(03)V9(02).
             10  A-ADJ-COIN            PIC 9(05)V9(02).
             10  A-RED-COIN            PIC 9(05)V9(02).
             10  A-BLOOD-LN-DEDUCT     PIC 9(05)V9(02).
             10  A-RETURN-CODE         PIC 9(02).



      ***************************************************************
      *   BELOW ARE THE CLAIM SERVICE LINES (INPUT FROM FISS)       *
      ***************************************************************
       01  OCE-IN-DATE.
           05  OCE-IN-LINES OCCURS 450 TIMES.
              10  FILLER               PIC X(15).
              10  OPPS-LITEM-DOS       PIC 9(08).
              10  OPPS-LITEM-RVCD      PIC X(04).
              10  FILLER               PIC X(19).


      ***************************************************************
      *    CY 2012 EDIT - MADE 02/07/2012:                          *
      *    - ADDED TYPE OF BILL - 3 BYTES                           *
      ***************************************************************
       01  L-TYPE-OF-BILL            PIC X(03).
           88 BILL-TYPE-14X          VALUE '14A' THRU '149'.


      ***************************************************************
      *    CY 2014 EDIT - EFFECTIVE 01/01/2014:                     *
      *    - ADDED DEVICE CREDIT - 9 BYTES  (VALUE CODE FD)         *
      ***************************************************************
       01  L-DEVICE-CREDIT      PIC 9(07)V9(02).


      ***************************************************************
      *    CY 2016 EDIT - EFFECTIVE 01/01/2016:                     *
      *    - ADDED 10 VALUE CODES - QN-QW - 9 BYTES EACH            *
      ***************************************************************
       01  L-PAYER-ONLY-VALUE-CODES.
      *-------------------------------------------------------------*
      *    QN, QO & QP - FOR PASS-THROUGH DEVICE OFFSET             *
      *-------------------------------------------------------------*
           05  L-PAYER-ONLY-VC-QN   PIC 9(07)V9(02).
           05  L-PAYER-ONLY-VC-QO   PIC 9(07)V9(02).
           05  L-PAYER-ONLY-VC-QP   PIC 9(07)V9(02).
      *-------------------------------------------------------------*
      *    QQ - FOR TERMINATED PROCEDURE WITH PASS-THROUGH DEVICE   *
      *-------------------------------------------------------------*
           05  L-PAYER-ONLY-VC-QQ   PIC 9(07)V9(02).
      *-------------------------------------------------------------*
      *    QR, QS & QT - FOR PT DRUG/BIOLOGICAL OFFSETS             *
      *-------------------------------------------------------------*
           05  L-PAYER-ONLY-VC-QR   PIC 9(07)V9(02).
           05  L-PAYER-ONLY-VC-QS   PIC 9(07)V9(02).
           05  L-PAYER-ONLY-VC-QT   PIC 9(07)V9(02).
      *-------------------------------------------------------------*
      *    QU - FOR DEVICE CREDIT CAP AMOUNT                        *
      *-------------------------------------------------------------*
           05  L-PAYER-ONLY-VC-QU   PIC 9(07)V9(02).
      *-------------------------------------------------------------*
      *    QV & QW - FOR FUTURE USE                                 *
      *-------------------------------------------------------------*
           05  L-PAYER-ONLY-VC-QV   PIC 9(07)V9(02).
           05  L-PAYER-ONLY-VC-QW   PIC 9(07)V9(02).
      ***************************************************************
      *    CY 2017 EDIT - EFFECTIVE 01/01/2017:                     *
      *    - ADDED 2 NEW PRIOR TOTALS                               *
      ***************************************************************
       01  L-PRIOR-OUTL-TOTAL       PIC 9(10)V9(02).
       01  L-PRIOR-PYMT-TOTAL       PIC 9(10)V9(02).



      ******************************************************************
      ******************************************************************
      ***                                                            ***
      **                                                              **
      **        OUTPATIENT PROSPECTIVE PAYMENT SYSTEM PRICER          **
      **        --------------------------------------------          **
      **                 PROCEDURE DIVISION START                     **
      **                                                              **
      ***                                                            ***
      ******************************************************************
      ******************************************************************

       PROCEDURE DIVISION  USING OPPS-LINE-CNT
                                 OCE-DATA
                                 A-ADDITIONAL-VARIABLES
                                 L-PROV-SPEC-AREA
                                 L-SERVICE-FROM-DATE
                                 BENE-DEDUCT
                                 BENE-BLOOD-PINTS
                                 OCE-IN-DATE
                                 L-TYPE-OF-BILL
                                 L-DEVICE-CREDIT
                                 L-PAYER-ONLY-VALUE-CODES
                                 L-PRIOR-OUTL-TOTAL
                                 L-PRIOR-PYMT-TOTAL.


