Outpatient Definitions and Methodology

Statistics for the Top 20 Ambulatory Payment Classifications (APCs)

All information in this report is taken from the Medicare Outpatient Prospective Payment System (OPPS) Limited Data Set which is updated annually by CMS based on the calendar year.  The file includes billing data for 100% of all Medicare fee-for-service claims for hospital outpatient services during the twelve months ending December 31.  The report is based on the most recent period available and is consistent with CMS cell size suppression policy.

The twenty Ambulatory Payment Classification Codes (APCs) with the highest total payment are ranked by amount and all others are summarized.  There are no APC codes for some procedures.  Averages are based on units of service (i.e. the number of units of the item or service delivered).

This report reflects Composite APCs. Composite APCs provide a single payment for a comprehensive diagnostic and/or treatment service that is typically reported with multiple HCPCS codes. When HCPCS codes that meet the criteria for payment of the composite APC are billed on the same date of service, a single payment is made for all of the codes as a whole, rather than paying each code individually. (Services that are grouped into a Composite APC are not reported individually on this report.) The grouping process is described in the CMS Internet-Only Manual (IOM) Pub. 100-04, Chapter 4, Section 10.2.1

Data included for each APC in this report are: