      *********************************************
      *   12/10/2015  RELEASE - V201611           *
      *                 PRODUCTION                *
      *********************************************
NOTE TO: Shared System Coordinators, MEDICARE Coordinators

SUBJECT: Outpatient Prospective Payment System (OPPS) Pricer System
         Release, Version 201611 (ASP)
(December 10, 2015)  --ACTION--refer to CMS change request CR #9486


This OPPS Pricer release is the updated version and is designed for
implementation in conjunction with the current OCE/APC V17.?
lines in the shared claims payment systems on or about 01Jan2016.

** NOTE: This Pricer has been tested in conjunction with the Janaury
         2016 IOCE pre-release software received 12/04/2015.  No
         Pricer issues were discovered by CMS during this second phase
         of testing.  Therefore, OPPSCAL was not altered.


This release includes the following updates:
--------------------------------------------
  - Added the ASP drug rates effective January 1, 2016 to the APC tables
    Added retroactive APC rate corrections/additions to the APC tables
    (BASEAPCS, OPPSAPCS)

  - Updated this README and the MANIFEST members for this release.


A partitioned data set (PDS) of the code
(MU00.@BF12390.OPPS.V201611.COBOL) is at the CMS Data Center for users
to obtain by Connect:Direct (Network DataMover).

The 39 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.

28 copybooks  - --------,OPPSWNXC,OPPSAPCS,--------,OPPSOF08,--------,
                --------,--------,--------,DEVRED09,OPPSMH09,OPPSPH09,
                SSRFBN09,OPPSPTRH,OPPSPTRO,OPPSPTCH,OPPSPTCO,DEVRED10,
                OPPSMH10,OPPSPH10,SSRFBN10,SSRFB10B,OPPSPTDO,DEVRED11,
                DEVRED12,OPPSMH12,DEVRED13,OPPSMH13,OPPSPH13,DEVCR14 ,
                OPPSMH14,OPPSPH14,DEVCR15 ,DEVCR16.

7  databooks  - BASEAPCS,--------,BASEWNXC,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.





                              Tamara Howard
                              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

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

DEVCR16  - copybook of 2016 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
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

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.


       LINKAGE SECTION.

      ***************************************************************
      *        LAYUP TABLE AREA FOR 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-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).

       01  OCE-IN-DATE.
           05  OCE-IN-LINES OCCURS 450 TIMES.
              10  FILLER               PIC X(15).
              10  OPPS-LITEM-DOS       PIC 9(08).
              10  FILLER               PIC X(23).
      *       10  FILLER               PIC X(21). CHANGED 12/2/2008


      ***************************************************************
      *    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                          *
      ***************************************************************
       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 - 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).
      *-------------------------------------------------------------*
      *    QP - QW - FOR FUTURE USE                                 *
      *-------------------------------------------------------------*
           05  L-PAYER-ONLY-VC-QP   PIC 9(07)V9(02).
           05  L-PAYER-ONLY-VC-QQ   PIC 9(07)V9(02).
           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).
           05  L-PAYER-ONLY-VC-QU   PIC 9(07)V9(02).
           05  L-PAYER-ONLY-VC-QV   PIC 9(07)V9(02).
           05  L-PAYER-ONLY-VC-QW   PIC 9(07)V9(02).




   Pricer Output Fields Data Descriptions:
     A-CALC-VERS             - OPPSCAL release version
     A-TOTAL-CLM-DEDUCT      - Total deductible applied the claim
     A-OUTLIER-PYMT          - Outlier payment for the claim
                               associated with the OPPS lines
     A-TOT-CLM-PYMT          - Total claim payment amount used to
                               calculate the outlier amount
     A-TOT-CLM-CHRG          - Total claim charge amount used to
                               calculate the outlier amount
     A-CLM-RTN-CODE          - Claim level return code
     A-MSA                   - MSA for claim
     A-CBSA                  - CBSA for claim
     A-WINX                  - Wage Index for claim
     A-BLOOD-PINTS-USED      - Total blood pints used for claim
     A-BLOOD-DEDUCT-DUE      - Total blood deductible due for claim
     A-DEVICE-CREDIT-QD      - Total device credit applied to claim
     *********************************
     * A-LINE-ITEMS OCCURS 450 TIMES *
     *    DEPENDING ON OPPS-LINE-CNT.*
     *********************************
       A-LITEM-PYMT          - Total adjusted line payment
       A-LITEM-REIM          - Medicare program payment amount
       A-TOTAL-LN-DEDUCT     - Total deductible applied to the line
       A-ADJ-COIN            - Adjusted coinsurance amount
       A-RED-COIN            - Provider elected coinsurance or
                               minimum coinsurance allowed ; which
                               ever is greatest
       A-BLOOD-LN-DEDUCT     - Total blood deductible applied
                               to the line
       A-RETURN-CODE         - Line level retun code



   ***************************************************************
   *    PROCESSING:                                              *
   *        Below is the CALL STATEMENT and variables listed     *
   *             required by the OPPSCAL module.                 *
   ***************************************************************

       CALL OPPSCAL 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.

