Medicare Provider Charge Data: Outpatient

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) 2011.  The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.

For these APCs, 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.   For a more complete discussion of the claims criteria used in setting the Medicare payment rates for hospital outpatient services, see the Medicare CY 2013 Outpatient Prospective Payment System (OPPS) Claims Accounting document available on the CMS website at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/CMS-1589-FC-Claims-Accounting-narrative.pdf.  This estimated outpatient charge data supplements the inpatient charge data available on the CMS Medicare Provider Charge Data Inpatient website (available via the link in the left navigation bar).

Data are being made available in Microsoft Excel (.xlsx) format and comma separated values (.csv) format.

Outpatient Charge Data, CY2011, Microsoft Excel version
Outpatient Charge Data, CY2011, Comma Separated Values (CSV) version
 

National and State level summaries are also available here:

National and State Summaries of Outpatient Charge Data, CY2011, Microsoft Excel version
National and State Summaries of Outpatient Charge Data, CY2011, Comma Separated Values (CSV) version
 

Inquiries regarding this data can be sent to MedicareProviderChargeData@cms.hhs.gov.