A provider level summary of Outpatient Prospective Payment System (OPPS) average estimated submitted charges and average Medicare Payments for 30 selected Ambulatory Payment Classification (APC) Groups.
9/04/2013 UPDATE: As a result of using the OPPS ratesetting process to develop the summary of outpatient charge and payment data, we inadvertently excluded claims data for visit APCs 0604 (“Level 1 Hospital Clinic Visits”) and 0607 (“Level 4 Hospital Clinic Visits”). The revised outpatient data reflects changes to correct this, with volume increases in the summarized data for APCs 0604 and 0607.

The data provided here include estimated hospital-specific charges for 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2012. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.

The CMS 2010 BSA Outpatient Procedures PUF originates from a 5% simple random sample of beneficiaries drawn (without replacement) from the 100% Beneficiary Summary File for reference year 2010.

A provider level summary of Outpatient Prospective Payment System (OPPS) average estimated submitted charges and average Medicare Payments for 30 selected Ambulatory Payment Classification (APC) Groups.

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.

Hospital-Level Rates for AHRQ PSI-11: Post-Operative Respiratory Failure (data period: July 1, 2010 through June 30, 2012)

The data provided here include estimated hospital-specific charges for 32 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2014. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.

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 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 Outpatient Utilization and Payment national summary data 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 32 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2014. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.

The Outpatient Utilization and Payment state summary data 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 32 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2014. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.

The Outpatient Utilization and Payment national summary data 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 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2011. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.

The Outpatient Utilization and Payment state summary data 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 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2011. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.

The Outpatient Utilization and Payment state summary data 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 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2013. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.

The Outpatient Utilization and Payment national summary data 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 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2013. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.

The Outpatient Utilization and Payment national summary data 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 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2012. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.

The Outpatient Utilization and Payment state summary data 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 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2012. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.

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 35 C-APC Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for calendar year (CY) 2016. 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.

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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 35 C-APC Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for calendar year (CY) 2016. 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 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.