Hospital Outpatient Prospective Payment System (OPPS)

NOTICE: Please note that, as of April 2009, the OPPS Identifiable Data Set (IDS) is now considered a Limited Data Set (LDS).  The former identifiable version of the file is now the only version available.  The record layout below lists the data elements included on the new LDS, which include the elements from prior year versions of the IDS. This file has every element that was contained in the 2007 LDS and the 2007 IDS. Requestors should follow the link for Instructions on How to Request LDS Data Files below to obtain this file.

In the CY 2023 OPPS final rule, the final policy uses cost report data with cost reporting periods prior to the public health emergency (PHE) in CY 2023 OPPS ratesetting. The final OPPS Limited Data Set file contains select claim level data and is derived from 2021 hospital outpatient PPS claims, updated through June 2022, that is, claims for services furnished on or after January 1, 2021 through December 31, 2021 that were received, processed, paid, and passed to the National Claims History file by June 30, 2022. The cost report data used in the ratesetting process for this file includes cost reporting periods prior to the PHE. This file includes data elements such as diagnosis codes, bill type, outlier payments, and service revenue payments. This file includes more than 112 million claims for services paid under the OPPS, including multiple and single claims.  The record length is 13,603 and the blocksize is 32,760.

We are also providing another OPPS Limited Data Set file that would reflect the standard update for cost report data and uses data from during the PHE. However, this data was not used in CY 2023 OPPS ratesetting, as it did not reflect the policy finalized in the CY 2023 OPPS final rule. The additional file contains select claim level data and is derived from 2021 hospital outpatient PPS claims, updated through June 2022, that is, claims for services furnished on or after January 1, 2021 through December 31, 2021 that were received, processed, paid, and passed to the National Claims History file by June 30, 2022. The cost report data used in the ratesetting process for this file would use the standard cost report update, primarily cost reports beginning in CY 2020. This file includes data elements such as diagnosis codes, bill type, outlier payments, and service revenue payments. This file includes more than 113 million claims for services paid under the OPPS, including multiple and single claims.  The record length is 13,603 and the blocksize is 32,760.

The OPPS LDS file(s) will be available twice a year, for the NPRM in early summer and after publication of the OPPS final rule in the Federal Register in late fall. 

Media: DVD
Cost: $3,000  

Data Format:  CSV format with SAS® read-in program
Available: Final Rule 2023

To browse the record layout, see the Downloads section below.

Please follow the instructions on the DUA - Limited Data Sets page.

Page Last Modified:
11/04/2022 11:42 AM