National Summary of Outpatient Hospital Charge Data by APC and primary HCPCS, CY2015

data.cms.gov | Last Updated 15 Feb 2019

CPT copyright 2014 American Medical Association. All Rights Reserved. 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.

Tags: hcpcs, apc, mpup, outpatient, 2015, national

This dataset has the following 10 columns:

Column NameAPI Column NameData TypeDescriptionSample Values
APCapctextThe comprehensive APC code. In 2016, CMS renumbered the APC codes. Therefore, CY 2015 APC codes have different values from the CY 2016 APC codes. Appendix Table 1 contains a crosswalk between the CY 2015 and CY 2016 APC codes.
APC Descriptionapc_desctextThe description of the APC Code.
HCPCShcpcstextHCPCS code
HCPCS Descriptionhcpcs_desctextDescription of the HCPCS code.
Comprehensive APC Servicescapc_servicesnumberThe number of primary HCPCS services billed by the provider for outpatient hospital services.
Average Estimated Total Submitted Chargesaverage_total_submittednumberThe provider's average estimated submitted charge for services covered by Medicare for the APC. These will vary from hospital to hospital because of differences in hospital charge structures.
Average Medicare Allowed Amountaverage_medicare_allowednumberThe average of total regular payments the provider receives for the APC. It includes both Medicare direct provider payments as well as beneficiaries’ co-payment and deductible payments. It excludes special outlier payments which is reported in a separate column.
Average Medicare Payment Amountaverage_medicare_paymentnumberThe average of total regular payments the provider receives directly from Medicare. It excludes special outlier payments which is reported in a separate column.
Outlier Comprehensive APC Servicesoutlier_servicesnumberThe number of comprehensive APC services with outlier payments. This variable is blank in cases where the number of outlier services is fewer than 11.
Average Medicare Outlier Amountaverage_medicare_outliernumberThe average of outlier payments the provider receives directly from Medicare. OPPS APC payment amounts are based on the average costs for a set of services. In the event that a hospital’s costs for these services exceed a given threshold tied to the average APC payment, CMS must issue an outlier payment to the hospital to that service to compensate for the costly provision of service. This variable is blank in cases where the number of outlier services is fewer than 11.