Others titles
- OPPS Based Payment Caps 2024
- PROCSTAT for Outpatient Prospective Payment System 2024
- PROCSTAT for Outpatient Prospective Payment System 2023
Keywords
- CMS Fee Schedule
- Medicare Fee Schedule 2023
- Medicare Physician Fee Schedule
- Medicare Rate 2021
- Medicare Rate 2022
- Medicare Rate 2023
- Medicare Rate 2024
- OPPSCAP 2024
- OPPSCAP 2023
- OPPSCAP 2022
- OPPSCAP 2021
- OPPS Based Payment Caps
- Outpatient Prospective Payment System 2024
Outpatient Prospective Payment System OPPSCAP
This Outpatient Prospective Payment System (OPPSCAP) dataset contains the payment amounts after the application of the OPPS based payment caps, except for carrier priced codes. For carrier priced codes, the field only contains the OPPS based payment caps. Carrier prices, however, cannot exceed the OPPS based payment caps.
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Description
This dataset shows Section 5102(b) of the Deficit Reduction Act of 2005 that requires a payment cap on the technical component (TC) of certain diagnostic imaging procedures and the TC portions of the global diagnostic imaging services. This cap is based on the Outpatient Prospective Payment System (OPPS) payment. To implement this provision, the physician fee schedule amount is compared to the OPPS payment amount and the lower amount is used in the formula below to calculate payment.
2024 OPPS Non-Facility Payment Amount =
[(Work RVU * Work GPCI) + (OPPS Non-Facility PE RVU * PE GPCI) +
(OPPS MP RVU * MP GPCI)] * Conversion Factor
2024 OPPS Facility Payment Amount =
[Work RVU * Work GPCI) + (OPPS Facility PE RVU * PE GPCI) +
(OPPS MP RVU * MP GPCI)] * Conversion Factor
About this Dataset
Data Info
Date Created | 2015-05-28 |
---|---|
Last Modified | 2024-05-28 |
Version | 2024-05-28 |
Update Frequency |
Quarterly |
Temporal Coverage |
2024 |
Spatial Coverage |
United States |
Source | John Snow Labs; Centers for Medicare and Medicaid Services; |
Source License URL | |
Source License Requirements |
N/A |
Source Citation |
N/A |
Keywords | CMS Fee Schedule, Medicare Fee Schedule 2023, Medicare Physician Fee Schedule, Medicare Rate 2021, Medicare Rate 2022, Medicare Rate 2023, Medicare Rate 2024, OPPSCAP 2024, OPPSCAP 2023, OPPSCAP 2022, OPPSCAP 2021, OPPS Based Payment Caps, Outpatient Prospective Payment System 2024 |
Other Titles | OPPS Based Payment Caps 2024, PROCSTAT for Outpatient Prospective Payment System 2024, PROCSTAT for Outpatient Prospective Payment System 2023 |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
HCPCS | CPT or Level 2 HCPCS number for the service. | string | - |
Procedure_Status_Code | This column includes the Procedure Status Code. If, ‘A’ is listed in this column and indicates an Active Code, which means the code is paid if covered. R: Payment is restricted, although Medicare may reimburse for the service/procedure in some circumstances. These services are carrier-priced.C: The listed procedure or service is carrier priced. Although some carriers may choose to establish a fee schedule amount for some such codes, in most cases they will not. Therefore, the effective payment for “C” status codes is usually zero. | string | - |
Carrier_Code | Carrier Code used for Healthcare Common Procedure Coding System (HCPCS) | integer | level : Nominal |
Locality_Code | Locality Code used for Healthcare Common Procedure Coding System (HCPCS) | string | - |
Facility_Price | This column includes the fee schedule amount when a physician performs a procedure in a non-facility setting such as the office. (Non-facility fees are applicable to therapy procedures regardless of whether they are furnished in facility or non-facility settings.) | number | level : Nominal |
NonFacility_Price | This column includes the fee schedule amount when a physician performs a procedure in a non-facility setting such as the office. (Non-facility fees are applicable to therapy procedures regardless of whether they are furnished in facility or non-facility settings.) | number | level : Nominal |
Data Preview
HCPCS | Procedure Status Code | Carrier Code | Locality Code | Facility Price | NonFacility Price |
0633T | TC | 1112 | 5 | 148.37 | 148.37 |
0633T | TC | 1112 | 9 | 150.03 | 150.03 |
0633T | TC | 1112 | 17 | 123.78 | 123.78 |
0633T | TC | 1112 | 18 | 124.94 | 124.94 |
0633T | TC | 1112 | 51 | 137.01 | 137.01 |
0633T | TC | 1112 | 52 | 148.37 | 148.37 |
0633T | TC | 1112 | 53 | 136.99 | 136.99 |
0633T | TC | 1112 | 54 | 114.38 | 114.38 |
0633T | TC | 1112 | 55 | 114.35 | 114.35 |
0633T | TC | 1112 | 56 | 114.35 | 114.35 |