/ en Sat, 26 Apr 2025 01:30:31 -0500 Mon, 06 Jan 25 13:45:49 -0600 <div class="container"><div class="row"><div class="col-md-8"><p>Below are three spreadsheets, one comparing relative weights and payment rates at the APC level, using the most recent 2025 and 2024 Addendum A spreadsheets, as downloaded from the CMS website. The second spreadsheet makes similar comparisons at the HCPCS level.  The 2025 files are from the 2025 contractor file, dated 1-02-2025 (these are rates for January 1, 2025 through December 31, 2025). The 2024 rates are from the October Addendum contractor files –dated October 2, 2024. The third spreadsheet is an OPPS APC/HCPCS lookup tool that allows the user to pull-up basic descriptive and payment information for a code.</p><p><strong>The Addendum A spreadsheet contains these 5 tab</strong>s:</p><ul><li><u>2025 Add. A by APC</u>: compares 2024 and 2025 status indicators, relative weights, and payment rates for all APCs in APC order</li><li><u>2025 Add. A sorted</u>: same as previous tab but sorted by percent change in payment rate, from largest percentage loss to biggest percentage gain</li><li><u>2025 New APCs</u>: displays the new APCs</li><li><u>2025 Deleted APCs: displays the APCs deleted from 2025</u></li><li><u>2025 Status Indicators</u>:  as supplied by CMS, ADDENDUM D1.--OPPS PAYMENT STATUS INDICATORS FOR CY 2025</li></ul><p><strong>The Addendum B spreadsheet contains these 6 tabs:</strong></p><ul><li>­ <u>2025 Add. B by HCPCS</u>: compares 2024 and 2025 status indicators, relative weights, and payment rates for <u>all</u> HCPCS codes included in Addendum B; sorted by HCPCS code</li><li>­ <u>2025 Add. B by APC</u>: same as previous tab but sorted by APC and within APC by HCPCS code</li><li>­ <u>Status codes G and K</u>: comparisons for separately payable drugs and biologicals with status indicator G or K in the 2025 final rule are shown in this tab</li><li><u>2025 Add. M</u>:  as supplied by CMS, HCPCS Codes for Assignment to Composite APCs for CY 2025</li><li><u>2025 Add. O</u>: as supplied by CMS, New CY 2023 Category I and III CPT Codes Effective January 1, 2025</li><li>­ <u>2025 Status Indicators</u>:  as supplied by CMS, ADDENDUM D1.-- OPPS PAYMENT STATUS INDICATORS FOR CY 2025</li></ul><p><strong>The OPPS APC/HCPCS lookup tool spreadsheet contains the following tabs:</strong></p><ul><li>­ <u>APC Lookup</u>: Allows user to lookup basic information on a given APC. User chooses APC or types in APC in formula bar in cell “B2”. Spreadsheet automatically displays basic descriptive and relevant payment information and the associated HCPCS that belong to that APC. Cells are locked but content can be copied and pasted into another spreadsheet for manipulation.</li><li><u>HCPCS Lookup</u>: Allows user to lookup basic information on a given HCPCS. User chooses HCPCS or types in HCPCS in formula bar in cell “B2”. Spreadsheet automatically displays basic descriptive and relevant payment information and its associated APC.</li><li>­ <u>2025 Status Indicators</u>:  as supplied by CMS, ADDENDUM D1. OPPS PAYMENT STATUS INDICATORS FOR CY 2025</li></ul></div><div class="col-md-4"><h4 class="text-align-center"><span>Download the Spreadsheets below.</span></h4><h4><a href="/system/files/media/file/2025/01/comparison-of-final-2025-opps-addendum-a-with-october-2024-addendum-a.xlsx" target="_blank" title="2025 Addendum A Compared to October 2024">Comparison of Final 2025 OPPS Addendum A with October 2024 Addendum A</a></h4><h4><a href="/system/files/media/file/2025/01/comparison-of-2025-opps-addendum-b-with-october-2024-addendum-b.xlsx" target="_blank" title="2025 Addendum A Compared to October 2024">Comparison of 2025 OPPS Addendum B with October 2024 Addendum B</a></h4><h4><a href="/system/files/media/file/2025/01/2025-opps-apc-hcpcs-final-lookup-tool-spreadsheet.xlsx" target="_blank" title="2025 OPPS APC/HCPCS Final Lookup Tool Spreadsheet">2025 OPPS APC/HCPCS Final Lookup Tool Spreadsheet</a></h4></div></div></div> Mon, 06 Jan 2025 13:45:49 -0600 Dataset <div class="container"><div class="row"><div class="col-md-8"><p>Lookup Tool: The third spreadsheet is an OPPS APC/HCPCS lookup tool that allows the user to pull-up basic descriptive and payment information for a code.</p></div><div class="col-md-4"><p><a href="/dataset/2024-07-19-2025-nprm-addendum-b-compared-july-2024" target="_blank" title="2025 NPRM Addendum A Compared to July 2024">2025 NPRM Addendum A Compared to July 2024</a></p><p><a href="/dataset/2024-07-19-2025-nprm-addendum-b-compared-july-2024" target="_blank" title="2025 NPRM Addendum B Compared to July 2024">2025 NPRM Addendum B Compared to July 2024</a></p></div></div></div> Fri, 19 Jul 2024 05:27:25 -0500 Dataset <div class="container"><div class="row"><div class="col-md-8"><p>The Addendum A spreadsheet compares relative weights and payment rates at the APC level, using the 2025 proposed rule Addendum A compared to 2024 Addendum A.</p></div><div class="col-md-4"><p><a href="/dataset/2024-07-19-2025-nprm-addendum-b-compared-july-2024" target="_blank" title="2025 Addendum B Compared to July 204">2025 NPRM Addendum B Compared to July 2024</a></p><p><a href="/dataset/2024-07-19-2025-nprm-opps-lookup" target="_blank" title="2025 NPRM OPPS Lookup">2025 NPRM OPPS Lookup</a></p></div></div></div> Fri, 19 Jul 2024 05:07:46 -0500 Dataset <div class="container"><div class="row"><div class="col-md-8"><p>The Addendum B Spreadsheet compares relative weights and payment rates at the HCPCS level, using proposed rule Addendum B compared to 2024 Addendum B.</p></div><div class="col-md-4"><p><a href="/dataset/2024-07-19-2025-nprm-addendum-compared-july-2024" target="_blank" title="2025 NPRM Addendum A Compared to July 2024">2025 NPRM Addendum A Compared to July 2024</a></p><p><a href="/dataset/2023-07-27-2024-nprm-opps-lookup">2024 NPRM OPPS Lookup</a></p></div></div></div> Fri, 19 Jul 2024 05:00:20 -0500 Dataset <div class="container"> <div class="row"> <div class="col-md-8"> <p>Lookup Tool: The third spreadsheet is an OPPS APC/HCPCS lookup tool that allows the user to pull-up basic descriptive and payment information for a code.</p> </div> <div class="col-md-4"> <p><a href="/dataset/2023-07-27-2024-nprm-addendum-compared-july-2023">2024 NPRM Addendum A Compared to July 2023</a></p> <p><a href="/dataset/2023-07-27-2024-nprm-addendum-b-compared-july-2023">2024 NPRM Addendum B Compared to July 2023</a></p> </div> </div> </div> Thu, 27 Jul 2023 10:49:38 -0500 Dataset <div class="container"> <div class="row"> <div class="col-md-8"> <p>The Addendum B Spreadsheet compares relative weights and payment rates at the HCPCS level, using proposed rule Addendum B compared to 2023 Addendum B (July 1, 2023 file). Spreadsheet cells highlighted in yellow were calculated by Health Policy Alternatives; all other information is from CMS.</p> </div> <div class="col-md-4"> <p><a href="/dataset/2023-07-27-2024-nprm-addendum-compared-july-2023">2024 NPRM Addendum A Compared to July 2023</a></p> <p><a href="/dataset/2023-07-27-2024-nprm-opps-lookup">2024 NPRM OPPS Lookup</a></p> </div> </div> </div> Thu, 27 Jul 2023 10:46:57 -0500 Dataset <div class="container"> <div class="row"> <div class="col-md-8"> <p>The Addendum A spreadsheet compares relative weights and payment rates at the APC level, using the 2024 proposed rule Addendum A compared to 2023 Addendum A (July 1, 2023 file), as downloaded from the CMS website.</p> </div> <div class="col-md-4"> <p><a href="/dataset/2023-07-27-2024-nprm-addendum-b-compared-july-2023">2024 NPRM Addendum B Compared to July 2023</a></p> <p><a href="/dataset/2023-07-27-2024-nprm-opps-lookup">2024 NPRM OPPS Lookup</a></p> </div> </div> </div> Thu, 27 Jul 2023 10:44:44 -0500 Dataset /dataset/2023-03-16-drugs-adjusted-coinsurance-amounts-quarter-april-1-june-30-2023 <p>A <a href="https://www.cms.gov/files/document/reduced-coinsurance-part-b-rebatable-drugs-apr-1-june-30.pdf" target="_blank" title="CMS.gov: Reduced Coinsurance for Certain Part B Rebatable Drugs under the Medicare Prescription Drug Inflation Rebate Program">March 15 fact sheet issued by CMS</a> includes a list of the first set of Part B rebatable drugs that will be subject to the adjusted coinsurance amounts for the quarter April 1-June 30, 2023.</p> <p>A list of these 27 drugs and biologicals follows:</p> table, th, td { border: 1px solid; } tr:hover {background-color: #b9d9eb33;} <table> <tbody> <tr> <th><strong>HCPCS Code</strong></th> <th><strong>Short Description</strong></th> <th><strong>Inflation-Adjusted Coinsurance Percentage (%)<a href="#fn1">*</a></strong></th> </tr> <tr> <td>J0287</td> <td>Abelcet</td> <td>19.180</td> </tr> <tr> <td>J8655</td> <td>Akynzeo</td> <td>16.213</td> </tr> <tr> <td>J7504</td> <td>Atgam</td> <td>17.830</td> </tr> <tr> <td>J3145</td> <td>Aveed</td> <td>19.239</td> </tr> <tr> <td>J0558</td> <td>Bicillin C-R</td> <td>18.921</td> </tr> <tr> <td>J0561</td> <td>Bicillin L-A</td> <td>18.514</td> </tr> <tr> <td>J1955</td> <td>Carnitor</td> <td>13.918</td> </tr> <tr> <td>J0850</td> <td>Cytogam</td> <td>18.983</td> </tr> <tr> <td>J9269</td> <td>Elzonris</td> <td>19.969</td> </tr> <tr> <td>J0699</td> <td>Fetroja</td> <td>10.274</td> </tr> <tr> <td>J1572</td> <td>Flebogamma DIF</td> <td>17.655</td> </tr> <tr> <td>J9307</td> <td>Folotyn</td> <td>19.965</td> </tr> <tr> <td>J1645</td> <td>Fragmin</td> <td>13.995</td> </tr> <tr> <td>J0135</td> <td>Humira</td> <td>19.529</td> </tr> <tr> <td>J2820</td> <td>Leukine</td> <td>19.648</td> </tr> <tr> <td>J2265</td> <td>Minocin</td> <td>19.288</td> </tr> <tr> <td>J0888</td> <td>Mircera</td> <td>17.614</td> </tr> <tr> <td>J9268</td> <td>Nipent</td> <td>17.269</td> </tr> <tr> <td>J9177</td> <td>Padcev</td> <td>19.470</td> </tr> <tr> <td>J9061</td> <td>Rybrevant</td> <td>19.747</td> </tr> <tr> <td>J2502</td> <td>Signifor LAR</td> <td>18.406</td> </tr> <tr> <td>J2860</td> <td>Sylvant</td> <td>19.777</td> </tr> <tr> <td>Q2053</td> <td>Tecartus</td> <td>19.958</td> </tr> <tr> <td>J2792</td> <td>Winrho SDF</td> <td>19.882</td> </tr> <tr> <td>J0775</td> <td>Xiaflex</td> <td>18.960</td> </tr> <tr> <td>J3299</td> <td>Xipere</td> <td>18.969</td> </tr> <tr> <td>Q2041</td> <td>Yescarta</td> <td>19.937</td> </tr> </tbody> </table> <p id="fn1"><small>* Normally 20%</small></p> Thu, 16 Mar 2023 13:33:04 -0500 Dataset Wed, 16 Nov 2022 11:36:36 -0600 Dataset /dataset/2022-10-24-data-brief-financial-challenges-hospitals-persist-through-2022 <h2><span>Executive Summary and Actions Needed from Congress</span></h2> <div class="container"> <div class="row"> <div class="col-md-8"> <p>To achieve their mission of keeping people healthy and provide lifesaving care and essential public health services, hospitals and health systems must remain financially viable.</p> <p>For many hospitals and health systems that’s becoming increasingly difficult as they manage the aftermath and aftershocks of the most significant public health crisis in a century. All of this has occurred against the backdrop of deepening workforce shortages, broken supply chains, and historic levels of inflation that have increased the costs of caring for patients.</p> <p>Congress should take a number of actions to ensure that hospitals and health systems can provide the care and services that their patients and communities depend on.</p> <p>Among other actions, Congress should:</p> <ul> <li>Prevent any further damaging cuts to health programs, including stopping the 4% the Statutory Pay-As-You-Go (PAYGO) sequester from kicking in.<br>  </li> <li>Establish a temporary per diem payment targeted to hospitals to address the issue of hospitals not being able to discharge patients to post-acute care or behavioral facilities because of staffing shortages.<br>  </li> <li>Increase the number of Medicare-funded graduate medical education positions to address the need for additional physicians in the U.S.<br>  </li> <li>Extend or make permanent certain rural programs expiring on Dec. 16, which are critical for rural communities such as the low-volume adjustment and the Medicare dependent hospital program.<br>  </li> <li>Make permanent the regulatory relief provided through waivers under the Public Health Emergency that eliminated red tape and sparked innovation, such as the hospital at home program and the expansion of telehealth services.<br>  </li> <li>Pass the Improving Seniors Timely Access to Care Act, which streamlines prior authorization requirements under Medicare Advantage plans. The House passed the bill in September.<br>  </li> <li>Create a special statutory designation for certain hospitals that serve marginalized urban communities.</li> </ul> <p>View the detailed brief below.</p> </div> <div class="col-md-4"> <a href="/system/files/media/file/2022/10/data-brief-financial-challenges-for-hospitals-persist-through-2022.pdf" target="_blank" title="Click here to download the Data Brief: Financial Challenges for Hospitals Persist Through 2022 PDF."><img alt=" Cover Data Brief: Financial Challenges for Hospitals Persist Through 2022" data-entity-type="file" data-entity-uuid src="/sites/default/files/2022-10/data-brief-financial-challenges-for-hospitals-persist-through-2022-cover-512px.png"></a> <p> </p> <div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2022/10/data-brief-financial-challenges-for-hospitals-persist-through-2022.pdf" target="_blank" title="Data Brief: Financial Challenges for Hospitals Persist Through 2022 PDF.">Download the PDF</a></div> <p> </p> </div> </div> </div> Mon, 24 Oct 2022 12:07:26 -0500 Dataset