Hospital Outpatient Regulations and Notices

Medicare Program:  Proposed Changes to the Hospital Outpatient Prospective Payment System and CY 2008 Payment Rates; Proposed Changes to the Ambulatory Surgical Center Payment System and CY 2008 Payment Rates

Medicare and Medicaid Programs:  Proposed Changes to Hospital Conditions of Participation; Proposed Changes Affecting Necessary Provider Designations of Critical Access Hospitals, published in the Federal Register August 2, 2007; CMS-1392-P

This proposed rule, in part, would revise the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system.  In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system.  These changes would be applicable to services furnished on or after January 1, 2008.   

Additionally, this proposed rule, in part, would update the revised Medicare ambulatory surgical center (ASC) payment system to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).  In this proposed rule, we propose the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which the final policies of the ASC payment system would apply, and other pertinent ratesetting information for the CY 2008 ASC payment system.  These changes would be applicable to services furnished on or after January 1, 2008.

Downloads
Median Costs for Hospital Outpatient Services, by HCPCS code - This Excel file displays median costs, by HCPCS code, for services payable under the Hospital OPPS in calendar year 2008. The data are based on claims for hospital outpatient services provided January 1, 2006 through December 31, 2006. [ZIP, 265KB]  Median Costs for Hospital Outpatient Services, by ambulatory payment classification (APC) group - This Excel file displays median costs, by APC group, for services payable under the OPPS in calendar year 2008. The data are based on claims for hospital outpatient services provided January 1, 2006 through December 31, 2006. [ZIP, 23KB]  Median Costs for Drugs, Biologicals, Radiopharmaceuticals, Brachytherapy Sources, and Blood (without simulated CCRs) - This Excel file displays cost data, in HCPCS code order, for drugs, biologicals, radiopharmaceuticals, brachytherapy sources, and blood that are packaged or separately payable under the OPPS in calendar year 2008. The data are based on claims for hospital outpatient services provided January 1, 2006 through December 31, 2006. [ZIP, 54KB] - Updated 7/19/07  Addendum A - This Excel file lists, in APC order, the name, payment status indicator, relative weight, payment rate, and copayment amount(s) for the 2008 APC groups. [ZIP, 41KB]  Addendum B - This Excel file lists payment information by HCPCS code for the 2008 OPPS. [ZIP, 415KB]  Addendum C - This Excel file groups HCPCS codes payable under the 2008 OPPS by APC. [ZIP, 159KB]  Addendum D1 - This table lists the 2008 OPPS payment status indicators and what they signify. [PDF, 73KB]  Addendum D2 - This table describes comment indicators assigned to new and deleted HCPCS codes in Addendum B. [PDF, 7KB]  Addendum E - This Excel file lists HCPCS codes that would only be payable as inpatient procedures (inpatient list). [ZIP, KB]  FY2008 IPPS Wage Index, Table 4A FY2008 IPPS Wage Index, Table 4B FY2008 IPPS Wage Index, Table 4C FY2008 IPPS Wage Index, Table 4F  Addendum L - Out-Migration Wage Adjustment for CY 2008 [ZIP, 18KB]  Addendum M " Proposed HCPCS Codes for Assignment to Composite APCs [ZIP, 5KB] FY2008 IPPS Wage Index, Table 9A  FY2008 IPPS Wage Index, Table 9C 2008 OPPS Hospital-Specific Impacts - Provider-specific data [ZIP, 356KB]  2008 OPPS Hospital-Specific Impacts - File layout [PDF, 16KB]  2008 OPPS Claims Accounting [PDF, 61KB]  2008 OPPS Without Cost or With Credit Device Information [ZIP, 5KB]   Blood Revenue Code Cost to Charge Ratios (CCRs) File Layout [PDF, 12KB]  Blood Revenue Code Cost to Charge Ratios (CCRs) [ZIP, 117KB]  2008 OPPS Rural Regression Analysis Files - Rural Regression Data - Unchanged from 2006 [ZIP, 222KB]  2008 OPPS Rural Regression Analysis Files - Rural Regression Analysis Layout - Unchanged from 2006 [PDF, 11KB]  2008 OPPS Preamble Tables [ZIP, 97KB]
Related Links Inside CMS
CMS-1392-P ASC Proposed Rule
Related Links Outside CMS
CMS-1392-P [PDF, 3.47MB]