CY 2005 Hospital Outpatient Prospective Payment System

Changes to the Hospital Outpatient Prospective Payment System for Calendar Year 2005

CMS-1427-P
• PART 1 (PDF - 2.32 MB)
• PART 2 (PDF - 5.39 MB)
• PART 3 (PDF - 5.48 MB)
• PART 4 (PDF - 4.22 MB)
• PART 5 (PDF - 4.34 MB)

Supporting Data Files:

• Median Costs for Hospital Outpatient Services, by HCPCS code (ZIP 207KB) This Excel file displays median costs, by HCPCS code, for services payable under the hospital outpatient prospective payment system (OPPS) in calendar year 2005. The data are based on claims for hospital outpatient services provided January 1, 2003 through December 31, 2003. Updated 08/18/04
• Median Costs for Hospital Outpatient Services, by ambulatory payment classification (APC) group (ZIP 20KB) Updated 08/17/04 This Excel file displays median costs, by APC group, for services payable under the OPPS in calendar year 2005. The data are based on claims for hospital outpatient services provided January 1, 2003 through December 31, 2003.
• Median Costs for Drugs, Biologicals, and Radiopharmaceuticals (ZIP 43KB) This Excel file displays median costs, in HCPCS code order, for drugs, biologicals, and radiopharmaceuticals that are packaged or separately payable under the OPPS in calendar year 2005. The data are based on claims for hospital outpatient services provided January 1, 2003 through December 31, 2003.
• Addendum A (ZIP 42KB) This Excel file lists, in APC order, the name, payment status indicator, relative weight, payment rate, and copayment amount(s) proposed for the 2005 APC groups.
• Addendum B (ZIP 375KB) This Excel file lists payment information by HCPCS code proposed for the 2005 OPPS.
• Addendum C (ZIP 159KB) This Excel file groups HCPCS codes proposed for payment under the 2005 OPPS by APC.
• Addendum D (PDF 61KB)
  • Addendum D1 - This table lists the 2005 OPPS payment status indicators and what they signify.
  • Addendum D2 - This table describes proposed comment codes proposed for assignment to new and deleted HCPCS codes in Addendum B.
• Addendum E (ZIP 363KB) This Excel file lists HCPCS codes that would only be payable as inpatient procedures (inpatient list).
• Addendum H (PDF 91KB) Wage index for urban areas.
• Addendum I (PDF 16KB) Wage index for rural areas.
• Addendum J (PDF 26KB) Wage index for hospitals that are reclassified.
• Addendum K (PDF 39KB) Wage Index Adjustment for Commuting Hospital Employees
• Addendum L (PDF 90KB) Pre-Reclassified Wage Index for Urban Areas
• Addendum M (PDF 16KB) Pre-Reclassified Wage Index for Rural Areas
• Addendum N (PDF 30KB) Hospital Reclassifications and Redesignations by Individual Hospital Under Section 508 of Pub.L. 108-173
• 2005 OPPS Hospital-Specific Impacts
1. Provider-specific data (ZIP 286KB Excel)
2. File layout (PDF 14KB)
• 2005 OPPS Claims Accounting (PDF 24KB)
• Device Related Portions of Ambulatory Payment Classification Costs for 2005 As we state in the proposed rule to update the OPPS for CY 2005 (CMS-1427-P), we will review each pass-through device category on a case-by-case basis to determine whether device costs are packaged into the existing APC structure. Currently, we propose that there are none for the remaining 3 categories for 2005, and, therefore, we propose to set the offsets to $0. If, during 2005, we create a new device category and determine that our data contain identifiable device costs within the APCs, we would adjust the pass-through payment by means of adjusting the APC payment associated with the device, if the offset amount is greater than $0. We would announce such an offset amount in the program transmittal that announces the new device category. For 2005, we are proposing to use the device percentages that we developed for potential offsets in CY 2004, and apply those percentages to the CY 2005 payment amounts to obtain the 2005 offset amounts. See the links at http://www.cms.hhs.gov/regulations/hopps/2004f/default.asp for files related to the Device Related Portions of Ambulatory Payment Classification Costs for 2004.

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