Profile Definitions and Methodology

Outpatient Utilization Statistics by APC

All information in this report is taken from the Medicare Hospital OPPS Identifiable Data Set which is updated annually by CMS based on the service year (i.e. calendar year).  The file includes hospital outpatient billing data for 100% of all Medicare fee-for-service claims for outpatient services provided during the twelve months ending December 31.  The report is consistent with CMS Data Release policies.

Information is reported for the twenty Ambulatory Payment Classifications (APCs) representing the highest Medicare payment to the hospital.  APCs are defined by the procedures performed according to definitions published by CMS for the corresponding service year.  A list of APCs is provided for reference.

  • Note that the Number of Patient Claims may be less than the Units of Service provided (i.e. one claim may include multiple units of service for a procedure).
  • Average Charges are based on both covered and non-covered charges for all accommodations and services (related to the revenue code) for a billing period before reduction for the deductible and coinsurance amounts and before an adjustment for the cost of services provided.
  • Average Costs are based on charges adjusted to cost using the hospital's specific cost center cost-to-charge ratio.