Cal. Code Regs. tit. 8 § 9789.39

Current through Register 2024 Notice Reg. No. 25, June 21, 2024

Section 9789.39 - Update Table by Date of Service

(a) Federal Regulations by Date of Service--For services rendered before March 1, 2021.

The Federal Regulations can be accessed at: http://www.cms.gov/HospitalOutpatientPPS/ and the referenced sections are incorporated by reference and will be made available upon request to the Administrative Director.

	*Services Occurring On or After 7/15/2005*	*Services Occurring On or After 2/15/2006*	*Services Occurring On or After 3/1/2007*	*Services Occurring On or After 3/1/2008*

Title 42, Code of Federal
Regulations, § 419.2

Title 42, Code of Federal
Regulations, § 419.32

Title 42, Code of Federal		As amended; effective	As amended; effective	As amended; effective
Regulations, § 419.43		January 1, 2006	January 1, 2007	January 1, 2008

Title 42, Code of Federal				Amended; effective
Regulations, § 419.44				January 1, 2008

Title 42, Code of Federal
Regulations, § 419.62

Title 42, Code of Federal	As amended; effective
Regulations, § 419.64	January 1, 2005

Title 42, Code of Federal		As amended; effective
Regulations, § 419.66		January 1, 2006

	*Services Occurring On or After 3/1/2009*	*Services Occurring On or After 4/15/2010*	*Services Occurring On or After 9/15/2011*	*Services Occurring On or After 3/1/2012*

Title 42, Code of Federal
Regulations, § 419.2

Title 42, Code of Federal			As amended; effective	As amended; effective
Regulations, § 419.32			January 1, 2011	January 1, 2012

Title 42, Code of Federal	As amended; effective		As amended; effective	As amended; effective
Regulations, § 419.43	January 1, 2009		January 1, 2011	January 1, 2012

Title 42, Code of Federal
Regulations, § 419.44

Title 42, Code of Federal
Regulations, § 419.62

Title 42, Code of Federal		As amended; effective
Regulations, § 419.64		January 1, 2010

Title 42, Code of Federal		As amended; effective
Regulations, § 419.66		January 1, 2010

	*Services Occurring On or After 4/1/2013*	*Services Occurring On or After 12/1/2014*	*Services Occurring On After December 15, 2016*	*or Services Occurring On or After June 1, 2017*

Title 42, Code of Federal	As amended; effective	As amended; effective	As amended; effective	As amended; effective
Regulations, § 419.2	January 1, 2013	January 1, 2014	January 1, 2016	January 1, 2016

Title 42, Code of Federal	As amended; effective	As amended; effective	As amended; effective	As amended; effective
Regulations, § 419.32	January 1, 2013	January 1, 2014	January 1, 2016	January 1, 2017

Title 42, Code of Federal			As amended; effective	As amended; effective
Regulations, § 419.43			January 1, 2012	January 1, 2017

Title 42, Code of Federal			As amended; effective	As amended; effective
Regulations, § 419.44			January 1, 2016	January 1, 2017

Title 42, Code of Federal			Effective January 1, 2004	Effective January 1, 2004
Regulations, § 419.62

Title 42, Code of Federal			As amended; effective	As amended; effective
Regulations, § 419.64			January 1, 2015	January 1, 2015

Title 42, Code of Federal		As amended; effective	As amended; effective	As amended; effective
Regulations, § 419.66		January 1, 2014	January 1, 2016	January 1, 2017

	*Services Occurring On or After March 15, 2018*	*Services Occurring On or After February 15, 2019*	*Services Occuring On or After March 1, 2020*

Title 42, Code of Federal	As amended; effective	As amended; effective	As amended; effective
Regulations, § 419.2	January 1, 2016	January 1, 2016	January 1, 2016

Title 42, Code of Federal	As amended; effective	As amended; effective	As amended; effective
Regulations, § 419.32	January 1, 2018	January 1, 2019	January 1, 2020

Title 42, Code of Federal	As amended; effective	As amended; effective	As amended; effective
Regulations, § 419.43	January 1, 2017	January 1, 2017	January 1, 2017

Title 42, Code of Federal	As amended; effective	As amended; effective	As amended; effective
Regulations, § 419.44	January 1, 2017	January 1, 2017	January 1, 2017

Title 42, Code of Federal	Effective January 1, 2004	Effective January 1, 2004	Effective January 1, 2004
Regulations, § 419.62

Title 42, Code of Federal	As amended; effective	As amended; effective	As amended; effective
Regulations, § 419.64	January 1, 2015	January 1, 2015	January 1, 2015

Title 42, Code of Federal	As amended; effective	As amended; effective	As amended; effective
Regulations, § 419.66	January 1, 2017	January 1, 2017	January 1, 2020

Title 42, Code of Federal	Effective January 1, 2018	Effective January 1, 2018	Effective January 1, 2018
Regulations, § 419.71

(b) Update factors and Federal Register Notices by Date of Service

The Federal Register Notices can be accessed at: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient and the referenced sections are incorporated by reference and will be made available upon request to the Administrative Director. The Federal Regulations can be accessed at: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient and the referenced sections are incorporated by reference and will be made available upon request to the Administrative Director.

	*Services Occurring On or After 1/1/2004*	*Services Occurring On or After 7/15/2005*	*Services Occurring On or After 2/15/2006*	*Services Occurring On or After 3/1/2007*

Applicable FR Notices	(A) November 7, 2003	(A) November 15, 2004	(A) November 10, 2005	(A) November 24, 2006
	(CMS-1471-FC;	(CMS-1427-FC;	(CMS-1501-FC;	(CMS-1506-FC;
	68 FR 63398);	69 FR 65681);	70 FR 68515);	71 FR 67960);
	(B) December 31, 2003	(B) December 30, 2004	(B) December 23, 2005	(B) August 18, 2006
	(CMS-1471-CN;	(CMS-1427-CN;	(CMS-1501-CN2;	(CMS-1488-F;
	68 FR 75442);	69 FR 78315;	70 FR 76176);	71 FR 47870)
	(C) January 6, 2004	(C) August 11, 2004	(C) August 12, 2005	(C) October 11, 2006
	(CMS-1371-IFC;	(CMS-1428-F;	(CMS-1500-F;	(CMS-1488-N;
	69 FR 820);	69 FR 48916);	70 FR 47278);	71 FR 59886)
	(D) August 1, 2003	(D) December 30, 2004	(D) September 30, 2005
	(CMS-1470-F;	(CMS-1482-F2;	(CMS-1500-CN;
	68 FR 45346);	69 FR 78526	70 FR 57161)
	(E) August 11, 2003 (CMS-1470-F; 68 FR 47637)

APC Payment Rate	Addendum B	Addendum B	Addendum B	Addendum B
	(A) beginning on page	(A) beginning on	(A) beginning on	(A) beginning on
	63488 conformed to comply with	page 65887	page 68752	page 68283
	(B) beginning on page 75442 and (C) beginning on page 820

APC Relative Weight	Addendum B	Addendum B	Addendum B	Addendum B
	(A) beginning on page	(A) beginning on	(A) beginning on	(A) beginning on
	63488 conformed to comply with	page 65887	page 68752	page 68283
	(B) beginning on page 75442 and (C) beginning on page 820

Emergency Department	99281-99285	99281-99285	99281-99285	99281-99285
HCPCS Codes

HOPPS Addenda	Addenda A, B, D1, D2, E,	Addenda A, B, D1, D2,	Addenda A, B, D1, D2,	Addenda A, B, D1, D2,
	H, I, and J (A) beginning	and E (A) beginning at	E and L (A) beginning	at E, and L (A) beginning
	at page 63478; as changed by	page 65864	page 68729; and correction	at page 68231
	(B) beginning at page 75442;		(B) beginning at page 76176
	and (C) beginning at page 820

IPPS Tables		Tables 4A₁, 4A₂, 4B₁, 4B₂,	Tables 4A, 4B, 4C,	Tables 4A-1, 4A-2, 4B-1,
		4C₁, 4C₂ and 4J (D)	and 4J (D) beginning at	4B-2, 4C-1, 4C-2, and 4J
		beginning at page 78619	page 57163; and Tables	(C) beginning at page 59975
			4A, 4B, 4C, and 4J (C) beginning on page 47580

Labor-related Share	60% ((A) page 63458)	60% ((A) beginning at	60% ((A) beginning at	60% ((A) beginning at
		page 65842)	page 68551)	page 68003)

Market Basket	3.4% (D) page 45346	3.3% (C) page 49274	3.7% (C) page 47492	3.4% (B) page 48146
Inflation Factor

Outlier Threshold		$1,175 (A) at page 65846	$1,250 (A) at page 68565	$1,825(A) at page 68012

Surgical Procedure	10021-69990	10021-69990	10021-69990	10021-69990
HCPCS

Conversion Factor adjusted	$53.924 (2003 unadjusted	$55.703 (2004 unadjusted	$57.764 (2005 unadjusted	$59.728 (2006 unadjusted
for inflation factor	conversion factor of	conversion factor of	conversion factor of	conversion factor of
	52.151 x estimated inflation	$53.924 x estimated	$55.703 x estimated	$57.764 x estimated
	factor of 1.034)	inflation factor of 1.033)	inflation factor of 1.037)	inflation factor of 1.034)

Wage Index	Addenda H through J	Referenced in Addenda H	Referenced in (A)	Referenced in (A)
	(A) beginning at page 63682	through J (B) beginning at page 78316; wage index values are specified in Tables 4A₁ through 4C₂ (D) beginning at page 78619	beginning at page 68551; wage index values are specified in Tables 4A through 4C (D) beginning at page 57163; and as specified in Tables 4A through 4C (C) beginning at page 47580	beginning at page 68003; wage index values are specified in Tables 4A-1 through 4C-2 (C) beginning at page 59975

	*Services Occurring On or After 3/1/2008*	*Services Occurring On or After 3/1/2009*	*Services Occurring On or After 4/15/2010*	*Services Occurring On or After 9/15/2011*

Applicable FR Notices	(A) November 27, 2007	(A) November 18, 2008	(A) November 20, 2009	(A) November 24, 2010
	(CMS-1392-FC;	(CMS-1404-FC;	(CMS-1414-FC;	(CMS-1504-FC;
	CMS-1533-F2;	73 FR 68502);	74 FR 60316);	75 FR 71800);
	72 FR 66580);	(B) August 19, 2008	(B) December 31, 2009	(B) March 11, 2011
	(B) August 22, 2007	(CMS-1390-F;	(CMS-1414-CN;	(CMS-1504-CN;
	(CMS-1533-FC;	73 FR 48434);	74 FR 69502);	76 FR 13292);
	72 FR 47130);	(C) October 3, 2008	(C) August 27, 2009	(C) August 16, 2010
	(C) October 10, 2007	(CMS-1390-CN;	(CMS-1406-F;	(CMS-1498-F;
	(CMS-1533-CN2;	73 FR 57541);	74 FR 43754);	75 FR 50042);
	72 FR 57634);	(D) October 3, 2008	(D) October 7, 2009	(D) October 1, 2010
	(D) November 6, 2007	(CMS-1390-N;	(CMS-1406-CN;	(CMS-1498-F;
	(CMS-1533-CN3;	73 FR 57888);	74 FR 51496)	75 FR 60640)
	72 FR 62585);	(E) December 3, 2008
	(E) November 27, 2007	(CMS-1390-N2;
	(CMS-1392-FC;	73 FR 73656);
	CMS-1533-F2;	(F) January 26, 2009
	72 FR 66580);	(CMS-1404-CN;
	(F) February 22, 2008	74 FR 4343)
	(CMS-1392-CN; CMS-1533-CN)

APC Payment Rate	Addendum B	Addendum B	Addendum B	Addendum B
	(A) beginning on	(A) beginning on	(A) beginning on	(A) beginning on
	page 66993 conformed to	page 68934	page 60752	page 72331
	comply with correction	conformed to comply with	conformed to comply with	conformed to comply with
	published in	correction published in	correction published in	correction published in
	(F) beginning on page 9863	(F) beginning on page 4344	(B) page 69503	(B) page 13295

APC Relative Weight	Addendum B	Addendum B	Addendum B	Addendum B
	(A) beginning on	(A) beginning on	(A) beginning on	(A) beginning on
	page 66993 conformed to	page 68934 conformed to	page 60752 conformed to	page 72331 conformed to
	comply with correction	comply with correction	comply with correction	comply with correction
	published in	published in	published in	published in
	(F) beginning on page 9863	(F) beginning on page 4344	(B) page 69503	(B) page 13295

Emergency Department	99281-99285	99281-99285	99281-99285	99281-99285
HCPCS Codes

HOPPS Addenda	Addenda A, B, D1, D2,	Addenda A, B, D1, D2,	Addenda A, B, D1, D2,	Addenda A, B, D1, D2,
	E, L, and M (A) beginning	E, L, and M (A) beginning	E, L, and M (A) beginning	E, L, and M (A) beginning
	at page 66934; and	at page 68816; and	at page 60682; and	at page 72268; and
	corrections to addenda A,	corrections to addenda	corrections to addenda B	corrections to addendum B
	B, D2, and M (F) beginning at page 9862	A and B (F) beginning	and E (B) beginning	(B) on page 13295
		at page 4343	at page 69503

IPPS Tables	Tables 4A, 4B, and 4C	Tables 4A, 4B, 4C, and 4J	Tables 2, 4A, 4B, 4C, and 4J	Tables 2, 4A, 4B, 4C, and 4J
	(C) beginning at page 57698	(C) beginning at page 57956;	(C) beginning at page 44032;	(C) beginning at page 50451
	and Table 4J (B) beginning	and Tables 2 and 4J	as changed by correction to
	at page 47531 and correction	(E) beginning at page 73657	Tables 2, 4A, 4B, 4C, and 4J
	(C) beginning at page 57726		(D) beginning at page 51499

Labor-related Share	60% ((A) beginning at	60% ((A) beginning at	60% ((A) beginning at	60% ((A) beginning at
	page 66678)	page 68585)	page 60419)	page 71877)

+
Market Basket Inflation Factor	3.3% (B) page 47415	3.6% (B) page 48759	2.1% (C) page 44002	2.6% (C) page 50422

Outlier Threshold	$1,575 (A) at page 66686	$1,800 (A) at page 68594	$2,175 (A) at page 60428	$2,025 (A) at page 71889

Surgical Procedure	10021-69990	10021-69990	10021-69990	10021-69990
HCPCS

Conversion Factor adjusted	$61.699 (2007 unadjusted	$63.920 (2008 unadjusted	$65.262 (2009 unadjusted	$66.959 (2010 unadjusted
for inflation factor	conversion factor of	conversion factor of	conversion factor of	conversion factor of
	$59.728 x estimated	$61.699 x estimated	$63.920 x estimated	$65.262 x estimated
	inflation factor of 1.033)	inflation factor of 1.036)	inflation factor of 1.021)	inflation factor of 1.026)

Wage Index	Referenced in (A)	Referenced in (A)	Referenced in (A)	Referenced in (A)
	beginning at page 66678;	beginning at page 68585;	beginning at page 60419;	beginning at page 71877;
	wage index values are	wage index values are	wage index values are	wage index values are
	specified in Tables 4A through 4C	specified in Tables 4A through 4C	specified in Tables 4A through 4C	specified in Tables 4A through 4C
	(C) beginning at page 57698	(D) beginning at page 57956	(D) beginning at page 51505; and as specified in Tables 4A through 4C (C) beginning at page 44085	(C) beginning at page 50511

	*Services Occurring On or After 3/1/2012*	*Services Occurring On or After 9/1/2012*	*Services Occurring On or After 4/1/2013*	*Services Occurring On or After 9/1/2014*

Applicable FR Notices	(A) November 30, 2011	(A) November 30, 2011	(A) November 15, 2012
	(CMS-1525-FC;	(CMS-1525-FC;	(CMS-1589-FC;
	76 FR 74122);	76 FR 74122);	77 FR 68210)
	(B) January 4, 2012	(B) January 4, 2012
	(CMS-1525-CN;	(CMS-1525-CN;
	77 FR 217);	77 FR 217);
	(C) August 18, 2011	(C) August 18, 2011
	(CMS-1518-F;	(CMS-1518-F;
	76 FR 51476);	76 FR 51476);
	(D) September 26, 2011	(D) September 26, 2011
	(CMS-1518-CN3;	(CMS-1518-CN3;
	76 FR 59263)	76 FR 59263);
		(E) April 24, 2012 (CMS-1525-CN2; 77 FR 24409)

APC Payment Rate	Addendum B (A) conformed to comply with correction published in (B) found on CMS website at: http://www.cms.gov/HospitalOutpatientPPS	Addendum B (A) conformed to comply with corrections published in (B) and (E) found on CMS website at: http://www.cms.gov/HospitalOutpatientPPS	Addendum B (A) found on CMS website at: http://www.cms.gov/HospitalOutpatientPPS

APC Relative Weight	Addendum B (A) conformed to comply with correction published in (B) found on CMS website at: http://www.cms.gov/HospitalOutpatientPPS	Addendum B (A) conformed to comply with corrections published in (B) and (E) found on CMS website at: http://www.cms.gov/HospitalOutpatientPPS	Addendum B (A) found on CMS website at: http://www.cms.gov/HospitalOutpatientPPS

Emergency Department	99281-99285	99281-99285	99281-99285	99281-99285,
HCPCS Codes				99291, 99292, G0380-G0384, G0390

Facility Only Services				Services with a "NA" in the column labeled "Non-Facility NA Indicator" of the Medicare Physician Fee Schedule Relative Value File for Calendar Year 2014 (RVU14A), located at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html

HOPPS Addenda	Addenda A, B, D1, D2, E, L, and M (A) and corrections to addenda (B) found on CMS website at: http://www.cms.gov/HospitalOutpatientPPS	Addenda A, B, D1, D2, E, L, and M (A and E) and corrections to addenda (A) and (B) found on CMS website at: http://www.cms.gov/HospitalOutpatientPPS	Addenda A, B, D1, D2, E, L, and M (A) found on CMS website at: http://www.cms.gov/HospitalOutpatientPPS

IPPS Tables	Tables 2, 4A, 4B, 4C, and 4J (C) and correction (D) found on CMS website at: http://www.cms.hhs.gov/AcuteInpatientPPS/.		Tables 2, 4A, 4B, 4C, and 4J (C) and correction (D) found on CMS website at: http://www.cms.hhs.gov/AcuteInpatientPPS/.

Labor-related Share	60% ((A) beginning at page 74191)		60% (A) beginning at page 68285

Market Basket Inflation Factor	3.0% (A) page 74189		2.6% (A) page 68215

Medicare Physician Fee				Calendar Year 2014
Schedule Relative Value File				(RVU14A), located at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html

Outlier Threshold	$2,025 (B) at page 222		$2,025 (A) page 68297

Surgical Procedure HCPCS	10021-69990	10021-69990	10021-69990	10021-69990, G0413

Conversion Factor adjusted	$68.968 (2011 unadjusted		$70.761 (2012 unadjusted
for inflation factor	conversion factor of		conversion factor of
	$66.959 x estimated inflation factor of 1.03)		$68.968 x estimated inflation factor of 1.026)

Wage Index	Referenced in (A) beginning at page 74191; wage index values are specified in Tables 4A through 4C (C) found on the CMS web site at: http://www.cms.gov/AcuteInpatientPPS/		Referenced in (A) beginning at page 68285; wage index values are specified in Tables 4A through 4C found on the CMS web site at: http://www.cms.gov/AcuteInpatientPPS/

	*Services Occurring On or After 12/1/2014*	*Services Occurring On or After December 15, 2016 and Mid-year Updates*	*Services Occurring On or After June 1, 2017 and Mid-year Updates*	*Services Occurring On or After March 15, 2018 and Mid-year Updates*

Applicable FR Notices	(A) December 10, 2013 (CMS-1601-FC; 78 FR 74826)	(A) November 13, 2015 (CMS-1633-FC; 80 FR 70298)	(A) November 14, 2016 (CMS-1656-FC; 81 FR 79562)	(A) December 14, 2017 (CMS-1678-FC; 82 FR 59216, Republication)

	(B) August 19, 2013 (CMS-1599-F; 78 FR 50496)	(B) August 17, 2015 (CMS-1632-F; 80 FR 49326)	(B) January 3, 2017 (CMS-1656-CN; 82 FR 24)	(B) December 27, 2017 (CMS-1678-CN; 82 FR 61184)
	(C) October 3, 2013 (CMS-1599-CN2; 78 FR 61197)	(C) October 5, 2015 (CMS 1632-CN; 80 FR 60055)	(C) August 22, 2016 (CMS-1655-F; 81 FR 56762)	(C) August 14, 2017 (CMS-1677-F; 82 FR 37990)
	(D) October 3, 2013 (CMS-1599-IFC; 78 FR 61191)		(D) October 5, 2016 (CMS-1655-F Correction; 81 FR 68947)	(D) October 4, 2017 (CMS-1677-CN; 82 FR 46138; Final rule; correction)
	(E) January 2, 2014 (CMS-1599-CN3; 79 FR 61)
	(F) January 10, 2014 (CMS-1599-CN4; 79 FR 1741)
	(G) March 14, 2014 (CMS-1599-IFC2; 79 FR 15022)
	(H) June 17, 2014; (CMS-1599-N; 79 FR 34444)

Ambulatory Surgical		For services rendered on	For services occurring on	For services occurring on
Centers Payment System		or after December 15,	or after June 1, 2017,	or after March 15 2018,
Addenda		2016, Column A, of	Column A, of	Column A, of
		Addendum AA, entitled,	Addendum AA, entitled,	Addendum AA, entitled,
		"HCPCS Code" and	"HCPCS Code" and	"HCPCS Code" and
		Column A, of	Column A, of	Column A, of
		Addendum EE entitled,	Addendum EE entitled,	Addendum EE entitled,
		"HCPCS Code" located in	"HCPCS Code" located in	"HCPCS Code" located in
		"July 2016 ASC Approved	"April 2017 ASC	"Correction Notice
		HCPCS Code and	Approved HCPCS Code	Addendum AA, BB, DD1,
		Payment Rates" found	and Payment Rates"	DD2, EE" (CMS-1678-
		on CMS website at:	(april_2017_asc_addenda_	CN-ASC-Addendum-
		https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/index.htm	rev_20170329)	AA-BB-DD1-DD2-
				EE.zip)

			For services occurring on	For services occurring on
			or after July 1 2017,	or after April 1 2018,
			Column A, of	Column A, of
			Addendum AA, entitled,	Addendum AA, entitled,
			"HCPCS Code" and	"HCPCS Code" and
			Column A, of	Column A, of
			Addendum EE, entitled,	Addendum EE, entitled,
			"HCPCS Code" located in	"HCPCS Code" located in
			"July 2017 ASC Approved	"April 2018 ASC
			HCPCS Code and	Approved HCPCS Code
			Payment Rates"	and Payment Rates--
			(july_2017_asc_addenda1)	Updated 03/21/2018" (april_2018_asc_ addenda_updated_04 _01_2018b.xlsx)
			For services occurring on	For services occurring on
			or after October 1 2017,	or after July 1, 2018,
			Column A, of	Column A, of Addendum
			Addendum AA, entitled,	AA, entitled, "HCPCS
			"HCPCS Code" and	Code" and Column A, of
			Column A, of	Addendum EE, entitled,
			Addendum EE, entitled,	"HCPCS Code" located in
			"HCPCS Code" located in	"July 2018 ASC
			"October 2017 ASC	Approved HCPCS Code
			Approved HCPCS Code	and Payment Rates --
			and Payment Rates"	Updated 06/28/2018" (july_
			(october_2017_asc_addenda)	2018_asc_addenda_updated _06_28_2018.xlsx)

			Access the files on
			CMS website at:	For services occurring on
			https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/index.html	or after October 1, 2018,
				Column A, of Addendum
				AA, entitled, "HCPCS
				Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "October 2018 ASC Approved HCPCS Code and Payment Rates" (oct_2018_asc_addenda_updated_09_19 _2018.09212018cb.xlsx)

				Access the files on CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/index.html

APC Payment Rate	Addendum B (A) found on CMS website at: http://www.cms.gov/HospitalOutpatientPPS	For services rendered on or after December 15, 2016, Addendum B, dated July 2016, (A) found on CMS website at: http://www.cms.gov/HospitalOutpatientPPS	For services occurring on or after June 1, 2017, Addendum B, dated April 2017 (-- updated: 03/28/2017; april_2017_ web_addendum_ b.03.28.17)	For services occurring on or after March 15, 2018, Addendum B (CMS-1678- CN-2018-OPPS- Addendum-B.zip; 2018 CN Addendum B.11.29.17)

			For services occurring on	For services occurring on
			or after July 1, 2017,	or after April 1, 2018,
			Addendum B, dated	Addendum B, dated
			July 2017	April 2018
			(july_2017__	(2018_april_
			web_addendum_	web_addendum_
			b.06.13.17)	b.03.19.18final.xlsx)

			For services occurring on	For services occurring on
			or after October 1, 2017,	or after July 1, 2018,
			Addendum B, dated	Addendum B -- Updated
			October 2017	6/27/2018 (july_
			(october_2017__	addendum_b.07.01.18
			web_addendum_	revised06272018.xlsx)
			a.09.14.17)

				For services occurring on
			-- found on CMS website	or after October 1, 2018,
			at: http://www.cms.gov/HospitalOutpatientPPS	Addendum B (2018_
				october_web_addendum_b.10.01.18 no340brem.xlsx)

				Access the files on the CMS website at:
				https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html?redirect=/HospitalOutpatientPPS/

APC Relative Weight	Addendum B (A) found on CMS website at: http://www.cms.gov/HospitalOutpatientPPS	For services rendered on or after December 15, 2016, Addendum B, dated July 2016, (A) found on CMS website at: http://www.cms.gov/HospitalOutpatientPPS	For services occurring on or after June 1, 2017, Addendum B, dated April 2017 (-- updated: 03/28/2017; april_2017_ web_addendum_ b.03.28.17)	For services occurring on or after March 15, 2018, Addendum B (CMS-1678- CN-2018-OPPS- Addendum-B.zip; 2018 CN Addendum B.11.29.17)

			For services occurring on	For services occurring on
			or after July 1, 2017,	or after April 1, 2018,
			Addendum B, dated	Addendum B, dated
			July 2017	April 2018
			(july_2017__	(2018_april_
			web_addendum_	web_addendum_
			b.06.13.17)	b.03.19.18final.xlsx)

			For services occurring on	For services occurring on
			or after October 1, 2017,	or after July 1, 2018,
			Addendum B, dated	Addendum B -- Updated
			October 2017	6/27/2018 (july_
			(october_2017__	addendum_b.07.01.18
			web_addendum_	revised06272018.xlsx)
			a.09.14.17)

				For services occurring on
			-- found on CMS website	or after October 1, 2018,
			at: http://www.cms.gov/HospitalOutpatientPPS	Addendum B (2018_
				october_web_addendum_b.10.01.18 no340brem.xlsx)

				Access the files on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html?redirect=/HospitalOutpatientPPS/

Composite APCs (codes				For services occurring on
assigned status indicator				or after March 15, 2018,
"Q1," "Q2," "Q3," or "Q4")				payment rules payment rules are:
				* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
				* CMS 2018 OPPS Addendum D1
				* CMS 2018 OPPS Addendum M (corrected 12/4/2017)
				* Integrated OCE (IOCE) CMS Specifications V19.0 (effective 01/01/2018), sections 10-12, 20

				For services occurring on or after April 1, 2018, payment rules are:
				* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
				* CMS 2018 OPPS Addendum D1
				* CMS 2018 OPPS Addendum M (corrected 12/4/2017)
				* IOCE Quarterly Data Files V19.1 [ZIP, 46MB] (IntegOCEspecs V19.1.pdf), sections 6.4.1, 6.4.3, 6.4.5, and 6.5

				For services occurring on or after July 1, 2018, payment rules are:
				* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
				* CMS 2018 OPPS Addendum D1
				* CMS 2018 OPPS Addendum M (corrected 12/4/2017)
				* Revised IOCE Quarterly Data Files V19.2.R1 [ZIP, 9MB], sections 5.4.1, 5.4.3, 5.4.5, and 5.5

				For services occurring on or after October 1, 2018, payment rules are:
				* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
				* CMS 2018 OPPS Addendum D1
				* CMS 2018 OPPS Addendum M (corrected 12/4/2017)
				* IOCE Quarterly Data Files V19.3 [ZIP, 55MB], sections 5.4.1, 5.4.3, 5.4.5, and 5.5

				A copy of the IOCE is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm#6

				Access documents on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html?redirect=/HospitalOutpatientPPS/ and https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html

Comprehensive APCs				For services occurring on
(codes assigned status				or after March 15, 2018,
indicator "J1" or "J2") payment rules				payment rules are:
				* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.4, 290.5.2, and 290.5.3
				* CMS 2018 OPPS Addendum D1
				* CMS 2018 OPPS Addendum J (Revised 1/25/2018)
				* Integrated OCE (IOCE) CMS Specifications V19.0 (effective 01/01/2018), sections 7, 21, and Appendix L

				For services occurring on or after April 1, 2018, payment rules are:
				* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.4, 290.5.2, and 290.5.3
				* CMS 2018 OPPS Addendum D1
				* CMS 2018 OPPS Addendum J (Revised 1/25/2018)
				* IOCE Quarterly Data Files V19.1 [ZIP, 46MB] (IntegOCE-specsV19.1.pdf), sections 6.6.1, 6.6.1.1, 6.6.2, 6.6.3, 6.6.4, 6.6.4.1, and 6.6.4.2

				For services occurring on or after July 1, 2018, payment rules are:
				* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.4, 290.5.2, and 290.5.3
				* CMS 2018 OPPS Addendum D1
				* CMS 2018 OPPS Addendum J (Revised 1/25/2018)
				* Revised IOCE Quarterly Data Files V19.2.R1 [ZIP, 9MB], sections 5.6.1, 5.6.1.1, 5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

				For services occurring on or after October 1, 2018, payment rules are:
				* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.4, 290.5.2, and 290.5.3
				* CMS 2018 OPPS Addendum D1
				* CMS 2018 OPPS Addendum J (Revised 1/25/2018)
				* IOCE Quarterly Data Files V19.3 [ZIP, 55MB], sections 5.6.1, 5.6.1.1, 5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

				A copy of the IOCE is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm#6

				Access documents on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html?redirect=/HospitalOutpatientPPS/ and https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html

Emergency Department	99281-99285, 99291, 99292,	99281-99285, 99291,	99281-99285, 99291,	99281-99285, 99291,
HCP CS Codes	G0380-G0384, G0390	99292, G0380-G0384,	99292, G0380-G0384,	99292, G0380-G0384,
		G0390	G0390	G0390

Facility Only Services	Services with a "NA" in	Not applicable for services	Not applicable for services	Not applicable for
	the column labeled	rendered on or after	rendered on or after	services srendered on or
	"Non-Facility NA	December 15, 2016	December 15, 2016	after December 15, 2016
	Indicator" of the Medicare Physician Fee Schedule Relative Value File, by date of service, as adopted and incorporated by reference in the Official Medical Fee Schedule (OMFS) Physician Fee Schedule (Title 8 CCR sections 9789.12.1, et seq.). The (OMFS) Physician Fee Schedule is located at: http://www.dir.ca.gov/dwc/OMFS9904.htm and the Medicare Physician Fee Schedule Relative Value File is located at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
Film X-ray services and X				For services occurring on
-rays taken using computed				or after March 15, 2018,
radiography technology/				use modifier "FX" to
cassette-based imaging				report X-rays taken
payment reductions				using film, which requires a 20 percent payment reduction for such service. Use modifier "FY" to report X-rays taken using computed radiography technology/cassette-based imaging which requires a 7 percent payment reduction for such service. Apply payment rules set forth in:
				* December 14, 2017 (CMS-1678-FC; 82 FR 59216, Republished, section X.E., pages 59391 through 59393)
				* Medicare Claims Processing Manual, Chapter 4, section 20.6.14 (effective 01/01/2018) and section 20.6.15 (effective 01/01/2018)
				* CFR section 419.71

				For services occurring on or after April 1, 2018, use modifier "FX" to report X-rays taken using film, which requires a 20 percent payment reduction for such service. Use modifier "FY" to report X-rays taken using computed radiography technology/cassette-based imaging which requires a 7 percent payment reduction for such service. Apply payment rules set forth in:
				* December 14, 2017 (CMS-1678-FC; 82 FR 59216, Republished, section X.E., pages 59391 through 59393)
				* Medicare Claims Processing Manual, Chapter 4, section 20.6.14 (effective 01/01/2018) and section 20.6.15 (effective 01/01/2018)
				* CFR section 419.71
				* CMS' April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) CR 10515 Revised March 22, 2018, Transmittal R4005CP, section 6

				For services occurring on or after July 1, 2018, use modifier "FX" to report X-rays taken using film, which requires a 20 percent payment reduction for such service. Use modifier "FY" to report X-rays taken using computed radiography technology/cassette-based imaging which requires a 7 percent payment reduction for such service. Apply payment rules set forth in:
				* December 14, 2017 (CMS-1678-FC; 82 FR 59216, Republished, section X.E., pages 59391 through 59393)
				* Medicare Claims Processing Manual, Chapter 4, section 20.6.14 (effective 01/01/2018) and section 20.6.15 (effective 01/01/2018)
				* CFR section 419.71
				* CMS' April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) CR 10515 Revised March 22, 2018, Transmittal R4005CP, section 6

				For services occurring on or after October 1, 2018, use modifier "FX" to report X-rays taken using film, which requires a 20 percent payment reduction for such service. Use modifier "FY" to report X-rays taken using computed radiography technology/cassette-based imaging which requires a 7 percent payment reduction for such service. Apply payment rules set forth in:
				* December 14, 2017 (CMS-1678-FC; 82 FR 59216, Republished, section X.E., pages 59391 through 59393)
				* Medicare Claims Processing Manual, Chapter 4, section 20.6.14 (effective 01/01/2018) and section 20.6.15 (effective 01/01/2018)
				* CFR section 419.71
				* CMS' April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) CR 10515 Revised March 22, 2018, Transmittal R4005CP, section 6

				Access the Medicare Claims Processing Manual on the CMS website at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html

HOPPS Addenda	Addenda A, B, D1, D2, E, L, M, and P (A) found on CMS website at: http://www.cms.gov/HospitalOutpatientPPS	Addenda A, B, D1, D2, E, J, L, and M (A) found on CMS website at: http://www.cms.gov/HospitalOutpatientPPS	For services occurring on or after June 1, 2017, addenda:	For services occurring on or after March 15, 2018 addenda:
			* A (April 2017 (-- updated 3/20/2017; april_2017_web_addendum _a_03202017)	* A (2018 CN Addendum A.11.29.17)
				* B (2018 CN Addendum B.11.29.17)
			* B (April 2017 (-- updated 3/28/2017; april_2017_web_addendum _b.03.28.17)	* D1 (2018 Final Addendum 2018, NFRM Addendum D1.10.18.17)
			* D1 (2017 Final Addendum D1.10.11.16)	* D2 (2018 Final Addendum, 2018
			* D2 (2017 Final Addendum D2.10.11.16)	NFRM Addendum D2.10.18.17)
			* E (2017 Final Addendum E.10.20.16)	* E (2018 Final Addendum, 2018 NFRM Addendum E.10.18.17)
			* J (2017 NFRM Addendum J 2016 12.05.16)
			* L (2017 Final OPPS Addendum L)	* J (2018 NFRM Addendum J Revised 01-25-2018)
			* M (2017 Final Addendum M.10.20.16)
				* L (2018 Final Addendum, 2018 NFRM Addendum L_ final)
			* P (2017 Final Addendum P)
				* M (2018 CN Addendum M.12.04.17)
				* P (2018 NFRM CN Addendum P 11 20 17)

			For services occurring on	For services occurring
			or after July 1, 2017, addenda:	on or after April 1, 2018 addenda:
			* A (July 2017; july_2017_web_addendum _a.06.13.17)
				* A (April 2018; 2018_april_web_addendum _a.03.19.18final.xlsx)
			* B (July 2017; july_2017_web_addendum _b.06.13.17)
				* B (April 2018; 2018_april_web_addendum _b.03.19.18final.xlsx)
			* D1 (2017 Final Addendum D1.10.11.16)
				* D1 (2018 Final Addendum 2018, NFRM Addendum D1.10.18.17)
			* D2 (2017 Final Addendum D2.10.11.16)
			* E (2017 Final Addendum E.10.20.16)	* D2 (2018 Final Addendum, 2018 NFRM Addendum D2.10.18.17)
			* J (2017 NFRM Addendum J 2016 12.05.16)
				* E (2018 Final Addendum, 2018 NFRM Addendum E.10.18.17)
			* L (2017 Final OPPS Addendum L)
			* M (2017 Final Addendum M.10.20.16)	* J (2018 NFRM Addendum J Revised 01-25-2018)
			* P (2017 Final Addendum P)
				* L (2018 Final Addendum, 2018 NFRM Addendum L_ final)

			For services occurring on or	after October 1, 2017, M.12.04.17)

				* M (2018 CN Addendum addenda:
			* A (October 2017; october_2017 _web_ addendum_a.09.14.17)	* P (2018 NFRM CN Addendum P 11 20 17)
			* B (October 2017; october_ 2017 _web_ addendum_b.09.14.17)	For services occurring on or after July 1, 2018 addenda:
				* A (July 2018 -- Updated 6/27/2018; july_ addendum_a.07.01.18 revised06272018.xlsx)
			* D1 (2017 Final Addendum D1.10.11.16)
			* D2 (2017 Final Addendum D2.10.11.16)
				* B (July 2018 -- Updated 6/27/2018; july_addendum_ b.07.01.18 revised06272018.xlsx)
			* E (2017 Final Addendum E.10.20.16)
			* J (2017 NFRM Addendum J 2016 12.05.16)
				* D1 (2018 Final Addendum 2018, NFRM Addendum D1.10.18.17)
			* L (2017 Final OPPS Addendum L)
			* M (2017 Final Addendum M.10.20.16)	* D2 (2018 Final Addendum, 2018 NFRM Addendum D2.10.18.17)
			* P (2017 Final Addendum P)
				* E (2018 Final Addendum, 2018 NFRM Addendum E.10.18.17)
			Access the files on the CMS
			website at: http://www.cms.gov/HospitalOutpatientPPS	* J (2018 NFRM Addendum J Revised 01-25-2018)
				* L (2018 Final Addendum, 2018 NFRM Addendum L_final)
				* M (2018 CN Addendum M.12.04.17)
				* P (2018 NFRM CN Addendum P 11 20 17)

				For services occurring on or after October 1, 2018 addenda:
				* A (October 2018; 2018_october_web_ addendum_a.10.01.18 no_340brem.xlsx)
				* B (October 2018; 2018_october_web_ addendum_b.10.01.18 no340brem.xlsx)
				* D1 (2018 Final Addendum 2018, NFRM Addendum D1.10.18.17)
				* D2 (2018 Final Addendum, 2018 NFRM Addendum D2.10.18.17)
				* E (2018 Final Addendum, 2018 NFRM Addendum E.10.18.17)
				* J (2018 NFRM Addendum J Revised 01-25-2018)
				* L (2018 Final Addendum, 2018 NFRM Addendum L_final)
				* M (2018 CN Addendum M.12.04.17)
				* P (2018 NFRM CN Addendum P 11 20 17)
				Access the files on the CMS website at:
				https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html

IPPS Tables	Tables 2, 4A, 4B, 4C, and	Tables 2 and 3 found on	Tables 2 and 3 (CMS 1655-	Tables 2 and 3 (CMS-
	4J (B) found on CMS	CMS website at:	F and CN FY 2017	1677-F; CMS-1677-CN)
	website at: http://www.cms.hhs.gov/AcuteInpatientPPS/.	http://www.cms.hhs.gov/AcuteInpatientPPS/.	Tables 2 and 3) found on CMS website at: http://www.cms.hhs.gov/AcuteInpatientPPS/	found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2018-IPPS-Final-Rule-Home-Page.html?DLSort=0&DLEntries=10&DLPage=1&DLSortDir=ascending

Labor-related Share	60% ((A) beginning at	60% ((A) beginning at	60% ((A) beginning at	60% ((A) beginning at
	page 74950)	page 70359)	page 79597)	page 59258)

Market Basket Inflation Factor	2.5% (A) page 74949	2.4% (A) page 70351	2.7% (A) page 79595	2.7% (A) page 59222)

Medicare Physician Fee
Schedule Relative Value File	Medicare Physician Fee Schedule Relative Value File, by date of service, as adopted and incorporated by reference in the Official Medical Fee Schedule (OMFS) Physician Fee Schedule (Title 8 CCR sections 9789.12.1, et seq.). The (OMFS) Physician Fee Schedule is located at: http://www.dir.ca.gov/dwc/OMFS9904.htm and the Medicare Physician Fee Schedule Relative Value File is located at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html	Not applicable for services rendered on or after December 15, 2016	Not applicable for services rendered on or after December 15, 2016	Not applicable for services rendered on or after December 15, 2016

Surgical Procedure HCPCS	10021-69990, G0413	HCPCS codes listed in column A of July 2016 CMS' Ambulatory Surgical Center Payment System (ASC) Addendum AA, column A of July2016 CMS' ASC Addendum EE, and CPT codes 21811-21813, but, excluding HCPCS codes listed on CMS' HOPPS Addendum E as an inpatient only procedure.	For services rendered on	For services rendered on
			or after June 1, 2017,	or after March 15, 2018,
			HCPCS codes listed in	HCPCS codes listed in
			column A of April 2017	column A of January 2018
			CMS'Ambulatory Surgical	CMS' Ambulatory Surgical
			Center Payment System	Center Payment
			(ASC)Addendum AA,	System (ASC) corrected
			column A of April 2017	Addendum AA, column
			CMS' ASC Addendum	A of January 2018 CMS'
			EE, and CPT codes	ASC corrected Addendum
			21811-21813, and 36415,	EE, and CPT codes 21811-
			but excluding HCPCS	21813, and 36415, but,
			codes listed on CMS' 2017	excluding HCPCS codes
			HOPPS Addendum E	listed on CMS' 2018
			as an inpatient only	HOPPS Addendum E
			procedure. ASC Addenda AA	as an inpatient only
			may be found in: and EE	procedure.
			April 2017 --	ASC Addenda AA
			april_2017_asc_ addenda_rev_	and EE may be found in:
			20170329, at: (https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html) EE.zip) at:	"Correction Notice
			2017 HOPPS Addendum E	Addendum AA, BB, DD1,
			(2017 Final Addendum	DD2, EE" (CMS-1678-
			E.10.20.16) is found at:	CN-ASC-Addendum-
			https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1656-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending	AA-BB-DD1-DD2-
			For services rendered on	2018 HOPPS Addendum E
			or after July 1, 2017,	(2018 NFRM Addendum
			HCPCS codes listed in	E.10.18.17) is found at:
			column A of July 2017 CMS' Ambulatory Surgical Center Payment System (ASC) Addendum AA, column A of July 2017 CMS' ASC Addendum EE, and CPT codes 21811- 21813, and 36415, but, excluding HCPCS codes listed on CMS' 2017 HOPPS Addendum E as an inpatient only procedure.	https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1678-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSort Dir=descending For services rendered on or after April 1, 2018, HCPCS codes listed in column A, of April 2018 CMS' Ambulatory Surgical Center Payment System (ASC) Addendum AA, Column
			ASC Addenda AA and EE	A, of April 2018 CMS'
			may be found in: July	ASC Addendum EE,
			2017 - July_2017_asc_	and CPT codes 21811-
			addenda1: (https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html) 2017 HOPPS	21813, and 36415, but,
			Addendum E (2017 Final	excluding HCPCS codes
			ddendum E.10.20.16)	listed on CMS' 2018
			is found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1656-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending	HOPPS Addendum E as
				an inpatient only
				procedure. ASC Addenda
				AA and EE may be
				found in: "April 2018
				ASC Approved HCPCS Code
				and Payment Rates --
				Updated 03/21/2018"
				(april_2018_asc_addenda_
				updated_04_01_
				2018b.xlsx) at:
				https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html

			For services rendered on	2018 HOPPS Addendum
			or after October 1, 2017,	E (2018 NFRM Adden-
			HCPCS codes listed in	dum E.10.18.17) is found
			column A of October 2017	at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1678-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending
			CMS' Ambulatory Surgical
			Center Payment System
			(ASC) Adendum AA,
			column A of October
			2017 CMS' ASC
			Addendum EE, and
			CPT codes 21811-21813,
			and 36415, but, excluding
			HCPCS codes listed on
			CMS' 2017 HOPPS Addendum E as an inpatient only procedure.
			ASC Addenda AA and EE	For services rendered on
			may be found in: October	or after July 1, 2018,
			2017 -- october_2017_asc_	HCPCS codes listed in
			addenda: (https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html)	column A, of July 2018
			2017 HOPPS Addendum E	CMS'Ambulatory Surgical
			(2017 Final Addendum	Center Payment
			E.10.20.16) is found at:	System (ASC) Addendum
			https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1656-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir =descending	AA, Column A, of
				July 2018 CMS' ASC
				Addendum EE, and CPT
				codes 21811-21813, and
				36415, but, excluding
				HCPCS codes listed on
				CMS' 2018 HOPPS
				Addendum E as an
				inpatient only procedure.
				ASC Addenda AA and EE
				may be found in: "July
				2018 ASC Approved
				HCPCS Code and
				Payment Rates-- Updated 06/28/2018" (july_2018_asc_ addenda_updated_ 06_28_2018. xlsx) at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html 2018 HOPPS Addendum E (2018 NFRM Addendum E.10.18.17) is found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1678-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

				For services rendered on or after October 1, 2018, HCPCS codes listed in column A, of October 2018 CMS' Ambulatory Surgical Center Payment System (ASC) Addendum AA, Column A, of October 2018 CMS' ASC Addendum EE, and CPT codes 21811-21813, and 36415, but, excluding HCPCS codes listed on CMS' 2018 HOPPS Addendum E as an inpatient only procedure.

				ASC Addenda AA and EE may be found in: "October 2018 ASC Approved HCPCS Code and Payment Rates" (oct_2018_asc_addenda _updated_09_19_ 2018.09212018cb.xlsx) at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html

				2018 HOPPS Addendum E (2018 NFRM Addendum E.10.18.17) is found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1678-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

Conversion Factor adjusted	$72.530 (2013 unadjusted	$76.424 (2015 unadjusted	$78.488 (2016 unadjusted	$80.607 (2017 unadjusted
for inflation factor	conversion factor of $70.761 x estimated inflation factor of 1.025)	conversion factor of $74.633 x estimated inflation factor of 1.024)	conversion factor of $76.424 x estimated inflation factor of 1.027)	conversion factor of $78.488 x estimated inflation factor of 1.027)

Wage Index	Referenced in (A) beginning at page 74952; wage index values are specified in Tables 4A through 4C	Referenced in (A) beginning at page 70359; wage index values are specified	Referenced in (A) beginning at page 79597; wage index values are specified	Referenced in (A) beginning at page 59261; wage index values are
	(B) found on the CMS website at: http://www.cms.gov/AcuteInpatientPPS/InpatientPPS/	in Table 2 (B) found on the CMS website at http://www.cms.gov/AcuteInpatientPPS/InpatientPPS/	in Table 2 (D) found on the CMS website at http://www.cms.gov/AcuteInpatientPPS/InpatientPPS/	Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2018-IPPS-Final-Rule-Home-Page.html?DLSort=0&DLEntries=10& DLPage=1&DLSortDir=ascending

	*Services Occurring On or After February 15, 2019 and Mid-year Updates*

Applicable FR Notices	(A) November 21, 2018 (CMS-1695-FC; 83 FR 58818)
	(B) December 28, 2018 (CMS-1695-CN2; 83 FR 67083)
	(C) August 17, 2018 (CMS-1694-F; 83 FR 41144)
	(D) October 3, 2018 (CMS-1694-CN2; 83 FR 49836)

Ambulatory Surgical Centers	For services occurring on or after February 15, 2019, Column A, of Addendum AA, entitled, "HCPCS
Payment System Addenda	Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "January 2019 ASC Approved HCPCS Code and Payment Rates - Updated 01/29/2019" (jan_2019_asc_addenda_1_28_19.xlsx)

	For services occurring on or after April 1, 2019, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "April 2019 ASC Approved HCPCS Code and Payment Rates - Updated 3/28/2019" (Apr_2019_ASC_Addenda_3_27_2019)

	For services occurring on or after July 1, 2019, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "July 2019 ASC Approved HCPCS Code and Payment Rates - Updated 06/27/2019" (July_2019_ASC_Addenda.06262019.xlsx)

	For services occurring on or after October 1, 2019, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "October 2019 ASC Approved HCPCS Code and Payment Rates CORRECTIONS - Updated 10/15/2019" (October_2019_ASC_Addenda.CORRECTED.10152019.xlsx)

	Note:
	Access the files on CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/index.html

APC Payment Rate	For services occurring on or after February 15, 2019, Addendum B, dated January 2019 (january_2019_opps_web_addendum_b.12312018.xlsx)

	For services occurring on or after April 1, 2019, Addendum B, dated April 2019 (2019_April_Web_ Addendum_B.03222019.xlsx)

	For services occurring on or after July 1, 2019, Addendum B, dated July 2019 (July_2019_Web_Addendum_B.06212019.xlsx)

	For services occurring on or after October 1, 2019, Addendum B - Correction, dated October 2019 (2019_October_Web_ Addendum_B.CORRECTED.09292019.xlsx)

APC Relative Weight	For services occurring on or after February 15, 2019, Addendum B, dated January 2019 (january_2019_opps_web_ addendum_b.12312018.xlsx)

	For services occurring on or after April 1, 2019, Addendum B, dated April 2019 (2019_April_Web_ Addendum_B.03222019.xlsx)

	For services occurring on or after July 1, 2019, Addendum B, dated July 2019 (July_2019_Web_Addendum_B.06212019.xlsx)

	For services occurring on or after October 1, 2019, Addendum B - Correction, dated October 2019 (2019_October_Web_ Addendum_B.CORRECTED.09292019.xlsx)

Composite APCs (codes	For services occurring on or after February 15, 2019, payment rules are:
assigned status indicator "Q1,"	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
"Q2," "Q3," or "Q4") payment	* CMS 2019 OPPS Addendum D1
rules	* CMS 2019 OPPS Addendum M
	* IOCE Quarterly Data Files V20.0 [ZIP, 52MB], IntegOCEspecsV20.0.pdf, sections 5.4.1, 5.4.3, 5.4.5, and 5.5

	For services occurring on or after April 1, 2019, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2019 OPPS Addendum D1
	* CMS 2019 OPPS Addendum M
	* IOCE Quarterly Data Files V20.1 [ZIP, 50MB], IntegOCEspecsV20.1.pdf, sections 5.4.1, 5.4.3, 5.4.5, and 5.5

	For services occurring on or after July 1, 2019, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2019 OPPS Addendum D1
	* CMS 2019 OPPS Addendum M
	* IOCE Quarterly Data Files V20.2 [ZIP, 50MB], IntegOCEspecsV20.2.pdf, sections 5.4.1, 5.4.3, 5.4.5, and 5.5

	For services occurring on or after October 1, 2019, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2019 OPPS Addendum D1
	* CMS 2019 OPPS Addendum M
	* IOCE Quarterly Data Files V20.3 [ZIP, 50 MB] IntegOCEspecsV20.3.pdf, sections 4.4.1, 4.4.3, 4.4.5, and 4.5

	Note:
	A copy of the IOCE is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm#6

	Access documents on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html?redirect=/HospitalOutpatientPPS/ and CMS Claims Processing Manual at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html

Comprehensive APCs (codes	For services occurring on or after February 15, 2019, payment rules are:
assigned status indicator "J1"	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.4, 290.5.2, and 290.5.3
or "J2") payment rules	* CMS 2019 OPPS Addendum D1
	* CMS 2019 OPPS Addendum J
	* IOCE Quarterly Data Files V20.0 [ZIP, 52MB], IntegOCEspecsV20.0.pdf, sections 5.6.1, 5.6.1.1, 5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

	For services occurring on or after April 1, 2019, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2019 OPPS Addendum D1
	* CMS 2019 OPPS Addendum M
	* IOCE Quarterly Data Files V20.1 [ZIP, 50MB], IntegOCEspecsV20.1.pdf, sections 5.4.1, 5.4.3, 5.4.5, and 5.5

	For services occurring on or after July 1, 2019, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2019 OPPS Addendum D1
	* CMS 2019 OPPS Addendum M
	* IOCE Quarterly Data Files V20.2 [ZIP, 50MB], IntegOCEspecsV20.2.pdf, sections 5.4.1, 5.4.3, 5.4.5, and 5.5
	For services occurring on or after October 1, 2019, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2019 OPPS Addendum D1
	* CMS 2019 OPPS Addendum M
	* IOCE Quarterly Data Files V20.3 [ZIP, 50 MB] IntegOCEspecsV20.3.pdf, sections 4.4.1, 4.4.3, 4.4.5, and 4.5

	Note:
	A copy of the IOCE is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm#6

	Access documents on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html

	And CMS Claims Processing Manual at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending

Emergency Department HCPCS Codes	99281-99285, 99291, 99292, G0380-G0384, G0390

Facility Only Services	Not applicable for services rendered on or after December 15, 2016

Film X-ray services and	Use modifier "FX" to report X-rays taken using film, which requires a 20 percent payment reduction for
X-rays taken using computed radiography technology/cassette-based imaging payment reductions	such service. Use modifier "FY" to report X-rays taken using computed radiography technology/cassette-based imaging which requires a 7 percent payment reduction for such service. Apply payment rules set forth in:
	* December 14, 2017 (CMS-1678-FC; 82 FR 59216, Republished, section X.E., pages 59391 through 59393)
	* Medicare Claims Processing Manual, Chapter 4, section 20.6.14 (effective 01/01/2018) and section 20.6.15 (effective 1/01/2018)
	* CFR section 419.71
	* CMS' April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) CR 10515 Revised March 22, 2018, Transmittal R4005CP, section 6

	Access the Medicare Claims Processing Manual on the CMS website at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html

HOPPS Addenda	For services occurring on or after February 15, 2019 addenda:
	* A (January 2019; january_2019_opps_web_addendum_a.12312018.xlsx)
	* B (January 2019; january_2019_opps_web_addendum_b.12312018.xlsx)
	* D1 (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum D1.11012018.xlsx)
	* D2 (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum D2.11012018.xlsm)
	* E (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum E.11012018.xlsx)
	* J (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum J.11012018.xls)
	* L (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum L.11012018.xlsx)
	* M (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum M.11012018.xlsx)
	* P (2019 CN2 OPPS Addenda; 2019 CN2 Addendum P.12212018.xlsx)

	For services occurring on or after April 1, 2019 addenda:
	* A (April 2019; 2019_April_Web_Addendum_A.03222019.xlsx)
	* B (April 2019; 2019_April_Web_Addendum_B.03222019.xlsx)
	* D1 (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum D1.11012018.xlsx)
	* D2 (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum D2.11012018.xlsm)
	* E (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum E.11012018.xlsx)
	* J (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum J.11012018.xls)
	* L (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum L.11012018.xlsx)
	* M (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum M.11012018.xlsx)
	* P (2019 CN2 OPPS Addenda; 2019 CN2 Addendum P.12212018.xlsx)

	For services occurring on or after July 1, 2019 addenda:
	* A (July 2019; July_2019_Web_Addendum_A.06212019.xlsx)
	* B (July 2019; July_2019_Web_Addendum_B.06212019.xlsx)
	* D1 (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum D1.11012018.xlsx)
	* D2 (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum D2.11012018.xlsm)
	* E (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum E.11012018.xlsx)
	* J (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum J.11012018.xls)
	* L (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum L.11012018.xlsx)
	* M (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum M.11012018.xlsx)
	* P (2019 CN2 OPPS Addenda; 2019 CN2 Addendum P.12212018.xlsx)

	For services occurring on or after October 1, 2019 addenda:
	* A (October 2019; 2019_October_Web_Addendum_A.CORRECTED.09292019.xlsx)
	* B (October 2019; 2019_October_Web_Addendum_B.CORRECTED.09292019.xlsx)
	* D1 (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum D1.11012018.xlsx)
	* D2 (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum D2.11012018.xlsm)
	* E (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum E.11012018.xlsx)
	* J (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum J.11012018.xls)
	* L (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum L.11012018.xlsx)
	* M (CY2019 NFRM OPPS Addenda; CY2019 NFRM Addendum M.11012018.xlsx)
	* P (2019 CN2 OPPS Addenda; 2019 CN2 Addendum P.12212018.xlsx)

	Note:
	Access the files on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html

IPPS Tables	FY 2019 Tables 2, 3 and 4 (Wage Index Tables) (Final Rule and Correction Notice) [ZIP, 1MB] found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcutelnpatientPPS/FY2019-IPPS-Final-Rule-Home-Page-Items/FY2019-IPPS-Final-Rule-Tables.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending

Labor-related Share	60% (A) beginning at page 58863

Market Basket Inflation Factor	2.9% (A) page 58822

Medicare Physician Fee Schedule Relative Value File	Not applicable for services rendered on or after December 15, 2016

Surgical Procedure HCPCS	For services rendered on or after February 15, 2019, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "Jan 2019 ASC AA," Column A, of CMS' ASC "Jan 2019 ASC EE, and CPT codes 21811-21813, 33289, and 36415, but, excluding HCPCS codes listed on CMS' 2019 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "January 2019 ASC Approved HCPCS Code and Payment Rates - Updated-01/29/2019" (jan_2019_asc_addenda_1_28_19.xlsx) at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html

	2019 HOPPS Addendum E (CY2019 NFRM Addendum E.11012018.xlsx) is found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1695-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

	For services rendered on or after April 1, 2019, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "Apr 2019 ASC AA," Column A, of CMS' ASC "Apr 2019 ASC EE," and CPT codes 21811-21813, 33289, and 36415, but, excluding HCPCS codes listed on CMS' 2019 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "April 2019 ASC Approved HCPCS Code and Payment Rates - Updated 3/28/19" (Apr_2019_ASC_Addenda_3_27_2019) at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html

	2019 HOPPS Addendum E (CY2019 NFRM Addendum E.11012018.xlsx) is found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1695-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

	For services rendered on or after July 1, 2019, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "Jul 2019 ASC AA," Column A, of CMS' ASC "Jul 2019 ASC EE," and CPT codes 21811-21813, 33289, and 36415, but, excluding HCPCS codes listed on CMS' 2019 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "July 2019 ASC Approved HCPCS Code and Payment Rates - Updated 06/27/2019" (July_2019_ASC_Addenda.06262019.xlsx) at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html

	2019 HOPPS Addendum E (CY2019 NFRM Addendum E.11012018.xlsx) is found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1695-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

	For services rendered on or after October 1, 2019, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "Oct 2019 ASC AA," Column A, of CMS' ASC "Oct 2019 ASC EE," and CPT codes 21811-21813, 3289, and 36415, but, excluding HCPCS codes listed on CMS' 2019 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "October 2019 ASC Approved HCPCS Code and Payment Rates CORRECTIONS - Updated 10/15/2019" (October_2019_ASC_Addenda.CORRECTED.10152019.xlsx) at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/index.html

	2019 HOPPS Addendum E (CY2019 NFRM Addendum E.11012018.xlsx) is found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1695-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

Conversion Factor adjusted for inflation factor	$82.945 (2018 unadjusted conversion factor of $80.607 x estimated inflation factor of 1.029)

Wage Index	Referenced in (A) beginning at page 58876; wage index values are specified in Table 2 (C) and (D) found on the CMS website at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcutelnpatientPPS/FY2019-IPPS-Final-Rule-Home-Page-Items/FY2019-IPPS-Final-Rule-Tables.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending

	*Services Occurring On or After March 1, 2020 and Mid-year Updates*

Applicable FR Notices	(A) November 12, 2019 (CMS-1717-FC; 84 FR 61142)
	(B) January 3, 2020 (CMS-1717-CN; 85 FR 224)
	(C) August 16, 2019 (CMS-1716-F; 84 FR 42044)
	(D) October 8, 2019 (CMS-1716-CN2; 84 FR 53603)

Ambulatory Surgical Centers Payment System Addenda	For services occurring on or after March 1, 2020, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "CY 2020 CN ASC Addenda.12122019" (CY 2020 CN ASC Addenda.12122019.xlsx)

	For services occurring on or after April 1, 2020, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "April 2020 ASC Approved HCPCS Code and Payment Rates - Updated 04/09/2020 (cy2020 april asc addenda.04092020.xlsx)

	For services occurring on or after July 1, 2020, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "July 2020 ASC Approved HCPCS Code and Payment Rates - Updated 06/29/2020" (cy2020 july asc addenda.06292020.xlsx)

	For services occurring on or after October 1, 2020, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "October 2020 ASC Approved HCPCS Code and Payment Rates" (CY2020 October ASC Addenda.09282020.xlsx)

	Note:
	Access the files on CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/index.html

APC Payment Rate	For services occurring on or after March 1, 2020, Addendum B, dated February 4, 2020 (2020 CN Addendum B CORRECTION.02042020.xlsx

	For services on or after March 1, 2020, for HCPCS code C9803, Addendum B, April 2020 Correction (ZIP) dated May 4, 2020 (2020_april_web_addendum_b.05042020.xlsx)

	For services occurring on or after April 1, 2020, Addendum B, April 2020 CORRECTION (ZIP) dated May 4, 2020 (2020_april_web_addendum_b.05042020.xlsx)

	For services occurring on or after July 1, 2020, Addendum B, July 2020 dated June 26, 2020 (2020_july_web_ addendum_b.06262020.xlsx)

	For services occurring on or after October 1, 2020, Addendum B, October 2020 CORRECTION dated October 21, 2020 (2020_October_Web_Addendum_B.10212020.xlsx)

APC Relative Weight	For services occurring on or after March 1, 2020, Addendum B, dated February 4, 2020 (2020 Addendum B CORRRECTION.02042020.xlsx)

	For services on or after March 1, 2020, for HCPCS code C9803, Addendum B, April 2020 Correction (ZIP) dated May 4, 2020 (2020_april_web_addendum_b.05042020.xlsx)

	For services occurring on or after April 1, 2020, Addendum B, April 2020 CORRECTION (ZIP) dated May 4, 2020 (2020_april_web_addendum_b.05042020.xlsx)

	For services occurring on or after July 1, 2020, Addendum B, July 2020 dated June 26, 2020 (2020_july_web_ addendum_b.06262020.xlsx)

	For services occurring on or after October 1, 2020, Addendum B, October 2020 CORRECTION dated October 21, 2020 (2020_October_Web_Addendum_B.10212020.xlsx)

Composite APCs (codes	For services occurring on or after March 1, 2020, payment rules are:
assigned status indicator	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
"Q1," "Q2," "Q3," or "Q4")	* CMS 2020 OPPS Addendum D1
payment rules	* CMS 2020 OPPS Addendum M
	* IOCE Quarterly Data Files V21.0 [ZIP, 1.17MB], IntegOCEspecsV21.0.pdf, sections 5.4.1, 5.4.3, 5.4.5, and 5.5

	For services occurring on or after April 1, 2020, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2020 OPPS Addendum D1
	* CMS 2020 OPPS Addendum M
	* IOCE Quarterly Data Files V21.1 R2 Apr 2020 [ZIP, 1.53MB], IntegOCEspecsV21.1 R2 Apr 2020.pdf, sections 5.4.1, 5.4.3, 5.4.5, and 5.5

	For services occurring on or after July 1, 2020, payment rules are:
	Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2020 OPPS Addendum D1
	* CMS 2020 OPPS Addendum M
	* IOCE Quarterly Data Files V212.R0 July 2020 [ZIP, 25.5MB], IntegOCEspecsV21.2 July 2020.pdf, sections 5.4.1, 5.4.3, 5.4.5, and 5.5

	For services occurring on or after October 1, 2020, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2020 OPPS Addendum D1
	* CMS 2020 OPPS Addendum M
	* October 2020 IOCE Quarterly Data Files V213.R1 Re-Release (posted 10/05/2020) [ZIP, 27.5MB], IntegOCE specsV21.3 R1_Oct 20.pdf, sections 5.4.1, 5.4.3, 5.4.5, and 5.5

	Note:
	Access the IOCE on the CMS website at: https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/OCEQtrReleaseSpecs Access documents on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index and CMS Claims Processing Manual at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html

Comprehensive APCs (codes	For services occurring on or after March 1, 2020, payment rules are:
assigned status indicator "J1"	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.4, 290.5.2, and 290.5.3
or "J2") payment rules	* CMS 2020 OPPS Addendum D1
	* CMS 2020 OPPS Addendum J
	* IOCE Quarterly Data Files V21.0 [ZIP, 1.17MB], IntegOCEspecsV21.0.pdf, sections 5.6.1, 5.6.1.1, 5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

	For services occurring on or after April 1, 2020, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.4, 290.5.2, and 290.5.3
	* CMS 2020 OPPS Addendum D1
	* CMS 2020 OPPS Addendum J
	* IOCE Quarterly Data Files V21.1 R2 Apr 2020 [ZIP, 1.53MB], IntegOCEspecsV21.1 R2 Apr 2020.pdf sections 5.6.1, 5.6.1.1, 5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

	For services occurring on or after July 1, 2020, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.4, 290.5.2, and 290.5.3
	* CMS 2020 OPPS Addendum D1
	* CMS 2020 OPPS Addendum J
	* IOCE Quarterly Data Files V212.R0 July 2020 [ZIP, 25.5MB], IntegOCEspecsV21.2 July 2020.pdf, sections 5.6.1, 5.6.1.1, 5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

	For services occurring on or after October 1, 2020, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.4, 290.5.2, and 290.5.3
	* CMS 2020 OPPS Addendum D1
	* CMS 2020 OPPS Addendum J
	* October 2020 IOCE Quarterly Data Files V213.R1 Re-Release (posted 10/05/2020) [ZIP, 27.5MB], IntegOCE specsV21.3 R1_Oct 20.pdf, sections 5.6.1, 5.6.1.1, 5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

	Note:
	Access the IOCE on the CMS website: https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/OCEQtrReleaseSpecs

	Access documents on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index and CMS Claims Processing Manual at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending

Emergency Department HCPCS Codes	99281-99285, 99291, 99292, G0380-G0384, G0390

Facility Only Services	Not applicable for services rendered on or after December 15, 2016

Film X-ray services and	Use modifier "FX" to report X-rays taken using film, which requires a 20 percent payment reduction for
X-rays taken using computed radiography technology/cassette- based imaging payment reductions	such service. Use modifier "FY" to report X-rays taken using computed radiography technology/cassette-based imaging which requires a 7 percent payment reduction for such service. Apply payment rules set forth in:
	* December 14, 2017 (CMS-1678-FC; 82 FR 59216, Republished, section X.E., pages 59391 through 59393)
	* Medicare Claims Processing Manual, Chapter 4, section 20.6.14 (effective 01/01/2018) and section 20.6.15 (effective 01/01/2018)
	* CFR section 419.71
	* CMS' April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) CR 10515 Revised March 22, 2018, Transmittal R4005CP, section 6

	Access the Medicare Claims Processing Manual on the CMS website at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html

HOPPS Addenda	For services occurring on or after March 1, 2020 addenda:
	* A (January 2020 Addendum A CORRECTION; 2020 Addendum A CORRECTION.02042020.xlsx)
	* B (January 2020 Addendum B CORRECTION; 2020 Addendum B CORRECTION.02042020.xlsx)
	* D1 (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum D1.11012019.xlsx)
	* D2 (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum D2.11012019.xlsm)
	* E (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum E.11012019.xlsx)
	* J (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum J.11012019.xls)
	* L (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum L.11012019.xlsx)
	* M (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum M.11012019.xlsx)
	* P (CY2020 CN Addendum P; CY2020 CN Addendum P.12202019.xlsx)

	For services on or after March 1, 2020, for HCPCS code C9803:
	* B (April 2020 CORRECTION (ZIP); 2020_april_web_addendum_b.05042020.xlsx)

	For services occurring on or after April 1, 2020 addenda:
	* A (April 2020 Addendum A; 2020_april_web_addendum_a.03262020.xlsx)
	* B (April 2020 CORRECTION (ZIP); 2020_april_web_addendum_b.05042020.xlsx)
	* D1 (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum D1.11012019.xlsx)
	* D2 (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum D2.11012019.xlsm)
	* E (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum E.11012019.xlsx)
	* J (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum J.1101201.xls)
	* L (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum L.11012019.xlsx)
	* M (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum M.11012019.xlsx)
	* P (CY2020 CN Addendum P; CY2020 CN Addendum P.12202019.xlsx)

	For services occurring on or after July 1, 2020 addenda:
	* A (July 2020 Addendum A; 2020_july_web_addendum_a.06262020.xlsx)
	* B (July 2020 Addendum B; 2020_july_web_addendum_b.06262020.xlxs)
	* D1 (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum D1.11012019.xlsx)
	* D2 (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum D2.11012019.xlsm)
	* E (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum E.11012019.xlsx)
	* J (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum J.1101201.xls)
	* L (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum L.11012019.xlsx)
	* M (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum M.11012019.xlsx)
	* P (CY2020 CN Addendum P; CY2020 CN Addendum P.12202019.xlsx)

	For services occurring on or after October 1, 2020 addenda:
	* A (October 2020 CORRECTION Addendum A; 2020_October_Web_Addendum_A.10212020.xlsx)
	* B (October 2020 CORRECTION Addendum B; 2020_October_Web_Addendum_B.10212020.xlsx)
	* D1 (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum D1.11012019.xlsx)
	* D2 (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum D2.11012019.xlsm)
	* E (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum E.11012019.xlsx)
	* J (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum J.1101201.xls)
	* L (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum L.11012019.xlsx)
	* M (CY2020 NFRM OPPS Addenda; CY2020 NFRM Addendum M.11012019.xlsx)
	* P (CY2020 CN Addendum P; CY2020 CN Addendum P.12202019.xlsx)

	Note:
	Access the files on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html

IPPS Tables	FY 2020 Tables 2, 3 and 4 (Wage Index Tables) (Final Rule and Correction Notice) [ZIP, 1MB] found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcutelnpatientPPS/FY2020-IPPS-Final-Rule-Home-Page-Items/FY2020-IPPS-Final-Rule-Tables

Labor-related Share	60% (A) beginning at page 61184

Market Basket Inflation Factor	3% (A) page 61145

Medicare Physician Fee Schedule Relative Value File	Not applicable for services rendered on or after December 15, 2016

Surgical Procedure HCPCS	For services rendered on or after March 1, 2020, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "Jan 2020 ASC AA," Column A, of CMS' ASC "Jan 2020 ASC EE, and CPT codes 21811-21813, 33289, and 36415, but, excluding HCPCS codes listed on CMS' 2020 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "January 2020 ASC Approved HCPCS Code and Payment Rates - Updated 01/01/2020" (cy2020_january_asc_addenda.01022020.xlsx) at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates

	2020 HOPPS Addendum E (2020 NFRM Addendum E.11012019.xlsx) is found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1695-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

	For services rendered on or after April 1, 2020, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "Apr 2020 ASC AA," Column A, of CMS' ASC "Apr 2020 ASC EE, and CPT codes 21811-21813, 33289, and 36415, but, excluding HCPCS codes listed on CMS' 2020 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "April 2020 ASC Approved HCPCS Code and Payment Rates - Updated 04/09/2020" (cy2020_april_asc_addenda.04092020.xlsx on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates

	2020 HOPPS Addendum E (2020 NFRM Addendum E.11012019.xlsx) is found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1695-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

	For services rendered on or after July 1, 2020, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "CY 2020 Jul ASC AA," Column A, of CMS' ASC "CY 2020 Jul ASC EE", and CPT codes 21811-21813, 33289, and 36415, but, excluding HCPCS codes listed on CMS' 2020 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "July 2020 ASC Approved HCPCS Code and Payment Rates - Updated 06/29/2020" (cy2020_july_asc_adenda_06292020.xlsx) on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates

	2020 HOPPS Addendum E (2020 NFRM Addendum E.11012019.xlsx) is found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1695-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

	For services rendered on or after October 1, 2020, HCPCS codes listed in column A of CMS' Ambulatory Surgical Center Payment System (ASC) "CY 2020 Oct ASC AA," column A of CMS' ASC "CY 2020 Oct ASC EE", CPT codes 21811-21813, 33289, and 36415, but, excluding HCPCS codes listed on CMS' 2020 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "October 2020 ASC Approved HCPCS Code and Payment Rates" (CY2020_October_ASC_Addenda.09282020.xlsx) on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates

	2020 HOPPS Addendum E (2020 NFRM Addendum E.11012019.xlsx) is found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1695-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

Conversion Factor adjusted for inflation factor	$ 85.433 (2019 unadjusted conversion factor of $82.945 x estimated inflation factor of 1.03)

Wage Index	Referenced in (A) beginning at page 61184; wage index values are specified in Table 2 (C) and (D) found on the CMS website at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcutelnpatientPPS/FY2020-IPPS-Final-Rule-Home-Page-Items/FY2020-IPPS-Final-Rule-Tables

	Services Occurring On or After March 1, 2021 and Mid-year Updates

Applicable FR Notices	(A) December 29, 2020 (CMS-1736-FC; 85 FR 85866)
	(B) February 25, 2021 (CMS-1736-CN; 86 FR 11428)
	(C) September 18, 2020 (CMS-1735-F; 85 FR 58432)
	(D) December 7, 2020 (CMS 1735-CN; 85 FR 78748)

Applicable sections of	§ 419.2 (As amended; effective January 1, 2016)
Title 42, Code of	§ 419.32 (As amended; effective January 1, 2021)
Federal Regulations	§ 419.43 (As amended; effective January 1, 2017)
	§ 419.44 (As amended; effective January 1, 2017)
	§ 419.62 (Effective January 1, 2004)
	§ 419.64 (As amended; effective January 1, 2015)
	§ 419.66 (As mended; effective January 1, 2021)
	§ 419.71 (Effective January 1, 2018)

Ambulatory Surgical Centers Payment System Addenda	For services occurring on or after March 1, 2021, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "Correction Notice Addendum AA, BB, DD1, DD2, EE," (2021 CN ASC Addenda.022221.xlsx)

	For services occurring on or after April 1, 2021, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "April 2021 ASC Approved HCPCS Code and Payment Rates-Updated 03/25/2021," (April 2021 ASC Addenda.03242021.xlsx)

	For services occurring on or after July 1, 2021, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "July 2021 ASC Approved HCPCS Code and Payment Rates," (July 2021 ASC Addenda.06252021.xlsx)

	For services occurring on or after October 1, 2021, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "October 2021 ASC Approved HCPCS Code and Payment Rates," (Oct 2021 ASC Addenda.09222021.xlsx)

	Note:
	Access the files on CMS website at:
	https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/index.html

APC Payment Rate	For services occurring on or after March 1, 2021, Addendum B-Correction, dated February 22, 2021 (2021 CN Addendum B.022221.xlsx)

	For services occurring on or after April 1, 2021, Addendum B April 2021 (April 2021 OPPS Web Addendum B.03222021.xlsx)

	For services occurring on or after July 1, 2021, Addendum B July 2021 (July 2021 Web Addendum B.06212021.xlsx)

	For services occurring on or after October 1, 2021, Addendum B October 2021 (2021 October Web Addendum B.09212021.xlsx)

APC Relative Weight	For services occurring on or after March 1, 2021, Addendum B-Correction, dated February 22, 2021 (2021 CN Addendum B.022221.xlsx)

	For services occurring on or after April 1, 2021, Addendum B April 2021 (April 2021 OPPS Web Addendum B.03222021.xlsx)

	For services occurring on or after July 1, 2021, Addendum B July 2021 (July 2021 Web Addendum B.06212021.xlsx)

	For services occurring on or after October 1, 2021, Addendum B October 2021 (2021 October Web Addendum B.09212021.xlsx)

Composite APCs	For services occurring on or after March 1, 2021, payment rules are:
(codes assigned	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
status indicator	* CMS 2021 OPPS Addendum D1-Updated 01/12/2021 (2021 NFRM OPPS Addendum D1.01122021.xlsx)
"Q1," "Q2," "Q3,"	* CMS 2021 OPPS Addendum M
or "Q4") payment	* IOCE Quarterly Data Files V220.R0[ZIP, 28MB] IntegOCEspecsV22.0. Jan.21.pdf, sections 5.4.1, 5.4.3,
rules	5.4.5, and 5.5

	For services occurring on or after April 1, 2021, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2021 OPPS Addendum D1-Updated 01/12/2021 (2021 NFRM OPPS Addendum D1.01122021.xlsx)
	* CMS 2021 OPPS Addendum M
	* IOCE Quarterly Data Files V212.R0 April 2021 [ZIP, 28.1MB], IntegOCEspecs V22.1 Apr21.pdf, sections 5.4.1, 5.4.3, 5.4.5, and 5.5

	For services occurring on or after July 1, 2021, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2021 OPPS Addendum D1-Updated 01/12/2021 (2021 NFRM OPPS Addendum D1.01122021.xlsx)
	* CMS 2021 OPPS Addendum M
	* IOCE Quarterly Data Files V222.R0 July 2021 [ZIP. 28.1MB], IntegOCEspecs V22.2 Jul21.pdf, sections 5.4.1, 5.4.3, 5.4.5, and 5.5

	For services occurring on or after October 1, 2021, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2021 OPPS Addendum D1-Updated 01/12/2021 (2021 NFRM OPPS Addendum D1.01122021.xlsx)
	* CMS 2021 OPPS Addendum M
	* IOCE Quarterly Data Files V223.R1 October 2021 [ZIP, 25.6MB], IntegOCEspecs V22.3.R1 Oct 21.pdf, sections 5.4.1, 5.4.3, 5.4.5, and 5.5
	Note:
	Access the IOCE on the CMS website at: https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/OCEQtrReleaseSpecs

	Access documents on the CMS website at:
	https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index and CMS
	Claims Processing Manual at:
	https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending

Comprehensive	For services occurring on or after March 1, 2021, payment rules are:
APCs (codes	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.2.4, 10.4, 290.5.2, and 290.5.3
assigned status	* CMS 2021 OPPS Addendum D1-Updated 01/12/2021 (2021 NFRM OPPS Addendum D1.01122021.xlsx)
indicator "J1" or	* CMS 2021 OPPS Addendum J
"J2") payment	* IOCE Quarterly Data Files V220.R0[ZIP, 28MB] IntegOCEspecsV22.0._Jan.21.pdf, sections 5.6.1, 5.6.1.1,
rules	5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

	For services occurring on or after April 1, 2021, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.2.4, 10.4, 290.5.2, and 290.5.3
	* CMS 2021 OPPS Addendum D1-Updated 01/12/2021 (2021 NFRM OPPS Addendum D1.01122021.xlsx)
	* CMS 2021 OPPS Addendum J
	* IOCE Quarterly Data Files V212.R0 April 2021 [ZIP, 28.1MB], IntegOCEspecs V22.1 Apr21.pdf, sections 5.6.1, 5.6.1.1, 5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

	For services occurring on or after July 1, 2021, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.2.4, 10.4, 290.5.2, and 290.5.3
	* CMS 2021 OPPS Addendum D1-Updated 01/12/2021 (2021 NFRM OPPS Addendum D1.01122021.xlsx)
	* CMS 2021 OPPS Addendum J
	* IOCE Quarterly Data Files V222.R0 July 2021 [ZIP, 28.1MB], IntegOCEspecs V22.2 Jul21.pdf, sections 5.6.1, 5.6.1.1, 5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

	For services occurring on or after October 1, 2021, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.2.4, 10.4, 290.5.2, and 290.5.3
	* CMS 2021 OPPS Addendum D1-Updated 01/12/2021 (2021 NFRM OPPS Addendum D1.01122021.xlsx)
	* CMS 2021 OPPS Addendum J
	* IOCE Quarterly Data Files V223.R1 Oct 2021 [ZIP, 28.1MB], IntegOCEspecs V22.3.R1 Oct21.pdf, sections 5.6.1, 5.6.1.1, 5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

	Note:
	Access the IOCE on the CMS website at:
	https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/OCEQtrReleaseSpecs

	Access documents on the CMS website at:
	https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index and CMS
	Claims Processing Manual at:
	https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending

Emergency Department HCPCS Codes	99281-99285, 99291, 99292, G0380-G0384, G0390

Facility Only Services	Not applicable for services rendered on or after December 15, 2016

Film X-ray services and X-rays taken using computed radiography technology/cassette-based imaging payment reductions	Use modifier "FX" to report X-rays taken using film, which requires a 20 percent payment reduction for such service. Use modifier "FY" to report X-rays taken using computed radiography technology/cassette-based imaging which requires a 7 percent payment reduction for such service. Apply payment rules set forth in:
	* December 14, 2017 (CMS-1678-FC; 82 FR 59216, Republished, section X.E., pages 59391 through 59393)
	* Medicare Claims Processing Manual, Chapter 4, section 20.6.14 (effective 01/01/2018) and section 20.6.15
	(effective 01/01/2018)
	* CFR section 419.71
	* CMS' April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) CR 10515
	Revised March 22, 2018, Transmittal R4005CP, section 6

	Access the Medicare Claims Processing Manual on the CMS website at:
	https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html

HOPPS	For services occurring on or after March 1, 2021 addenda:
Addenda	* A (2021 Correction Notice OPPS Addendum A; 2021 CN Addendum A.022221.xlsx)
	* B (2021 Correction Notice OPPS Addendum B; 2021 CN Addendum B.022221.xlsx)
	* D1 (2021 NFRM OPPS Addenda; 2021 NFRM Addendum D1-Updated 01/12/2021)
	* D2 (2021 NFRM OPPS Addenda; 2021 NFRM Addendum D2.11302020.xlsm)
	* E (2021 NFRM OPPS Addenda; 2021 NFRM Addendum E.11302020.xlsx)
	* J (2021 NFRM OPPS Addenda; 2021 NFRM Addendum J.11302020.xls)
	* L (2021 NFRM OPPS Addenda; 2021 NFRM Addendum L.11302020.xlsx)
	* M (2021 NFRM OPPS Addenda; 2021 NFRM Addendum M.11302020.xlsx)
	* P (2021 Correction Notice OPPS Addendum P; 2021_CN_Addendum P.022221.xlsx)

	For services occurring on or after April 1, 2021 addenda:
	* A (Addendum A April 2021; April 2021 OPPS Web Addendum A.03222021.xlsx
	* B (Addendum B April 2021; April 2021 OPPS Web Addendum B.03222021.xlsx
	* D1 (2021 NFRM OPPS Addenda; 2021 NFRM Addendum D1-Updated 01/12/2021)
	* D2 (2021 NFRM OPPS Addenda; 2021 NFRM Addendum D2.11302020.xlsm)
	* E (2021 NFRM OPPS Addenda; 2021 NFRM Addendum E.11302020.xlsx)
	* J (2021 NFRM OPPS Addenda; 2021 NFRM Addendum J.11302020.xls)
	* L (2021 NFRM OPPS Addenda; 2021 NFRM Addendum L.11302020.xlsx)
	* M (2021 NFRM OPPS Addenda; 2021 NFRM Addendum M. 11302020.xlsx)
	* P (2021 Correction Notice OPPS Addendum P; 2021 CN Addendum P.022221.xlsx)

	For services occurring on or after July 1, 2021 addenda:
	* A (Addendum A July 2021; July 2021 Web Addendum A.06212021)
	* B (Addendum B July 2021; July 2021 OPPS Web Addendum B. 06212021.xlsx)
	* D1 (2021 NFRM OPPS Addenda; 2021 NFRM Addendum D1-Updated 01/12/2021)
	* D2 (2021 NFRM OPPS Addenda; 2021 NFRM Addendum D2.11302020.xlsm)
	* E (2021 NFRM OPPS Addenda: 2021 NFRM Addendum E.11302020.xlsx)
	* J (2021 NFRM OPPS Addenda; 2021 NFRM Addendum J.11302020.xls)
	* L (2021 NFRM OPPS Addenda; 2021 NFRM Addendum L. 11302020.xlsx)
	* M (2021 NFRM OPPS Addenda; 2021 NFRM Addendum M.11302020.xlsx)
	* P (2021 Correction Notice OPPS Addendum P; 2021 CN Addendum P.022221.xlsx)

	For services occurring on or after October 1, 2021 addenda:
	* A (Addendum A October 2021; 2021 Oct Web Addendum A.09212021.xlsx)
	* B (Addendum B October 2021; 2021 Oct Web Addenda B.09212021.xlsx)
	* D1 (2021 NFRM OPPS Addenda; 2021 NFRM Addendum D1-Updated 01/12/2021)
	* D2 (2021 NFRM OPPS Addenda; 2021 NFRM Addendum D2.11302020.xlsm)
	* E (2021 NFRM OPPS Addenda; 2021 NFRM Addendum E.11302020.xlsx)
	* J (2021 NFRM OPPS Addenda; 2021 NFRM Addendum J.11302020.xls)
	* L (2021 NFRM OPPS Addenda; 2021 NFRM Addendum L. 11302020.xlsx)
	* M (2021 NFRM OPPS Addenda; 2021 NFRM Addendum M. 11302020.xlsx)
	* P (2021 Correction Notice OPPS Addendum P; 2021 CN Addendum P.022221.xlsx)

	Note:
	Access the files on the CMS website at:
	https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html

IPPS Tables	FY 2021 Tables 2, 3 and 4A and 4B (Wage Index Tables) (Final Rule and Correction Notice) [ZIP, 1.29MB] found at: https://www.cms.gov/medicare/acute-inpatient-pps/fy-2021-ipps-final-rule-home-page

Labor-related Share	60% (A) beginning at page 85906

Market Basket Inflation Factor	2.4% (A) at page 85869

Medicare Physician Fee Schedule Relative Value File	Not applicable for services rendered on or after December 15, 2016

Surgical Procedure	For services rendered on or after March 1, 2021, HCPCS codes listed in column A, of CMS' Ambulatory
HCPCS	Surgical Center Payment System (ASC) "CY 2021 CN ASC AA," Column A, of CMS' ASC "CY 2021 CN ASC EE, and CPT codes 20560, 20561, 21811-21813, 33289, 36415, and 36456, but, excluding HCPCS codes listed on CMS' 2021 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "Correction Notice Addendum AA, BB, DD1, DD2, EE" (2021 CN ASC Addenda.022221.xlsx) at:
	https://www.cms.gov/medicaremedicare-fee-service-paymentascpay-mentasc-regulations-and-notices/cms-1736-cn

	2021 HOPPS Addendum E (2021 NFRM Addendum E.11302020) is found at:
	https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1736-fc

	For services rendered on or after April 1, 2021, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "Apr 2021 ASC AA," Column A. of CMS' ASC "Apr 2021 ASC EE," and CPT codes 20560, 20561, 21811-21813, 33289, 36415, and 36456, but, excluding HCPCS codes listed on CMS' 2021 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "April 2021 ASC Approved HCPCS Code and Payment Rates-Updated 03/25/21" (April 2021 ASC Addenda.03242021.xlsx) at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/index.html

	2021 HOPPS Addendum E (2021 NFRM Addendum E.11302020) is found at: https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms1736-fc

	For services rendered on or after July 1, 2021, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "Jul 2021 ASC AA," Column A. of CMS' ASC "Jul 2021 ASC EE," and CPT codes 20560, 20561, 21811-21813, 33289, 36415, and 36456, but, excluding HCPCS codes listed on CMS' 2021 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "July 2021 ASC Approved HCPCS Code and Payment Rates" (July 2021 ASC Addenda.06252021.xlsx) at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/index.html

	2021 HOPPS Addendum E (2021 NFRM Addendum E.11302020) is found at: https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1736-fc

	For services rendered on or after October 1, 2021, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "Oct 2021 ASC AA," Column A, of CMS' ASC "Oct 2021 ASC EE," and CPT codes 20560, 20561, 21811-21813, 33289, 36415, and 36456, but, excluding HCPCS codes listed on CMS' 2021 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "October 2021 ASC Approved HCPCS Code and Payment Rates" (October 2021 ASC Addenda.09222021.xlsx) at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/index.html

	2021 HOPPS Addendum E (2021 NFRM Addendum E.11302020) is found at:
	https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientopshospital-outpatient-regulations-and-notices/cms-1736-fc

Conversion Factor adjusted for inflation factor	$ 87.483 (2020 unadjusted conversion factor of $85.433 x estimated inflation factor of 1.024)

Wage Index	Referenced in (A) beginning at page 85916; wage index values are specified in CN Table 2 (C) and (D) found on the CMS website at https://www.cms.gov/medicare/acute-inpatient-pps/fy-2021-ipps-final-rule-home-page#1735

	*Services Occurring On or After March 1, 2022 and Mid-year Updates*

Applicable FR Notices	(A) November 16, 2021 (CMS-1753-FC; 86 FR 63458)
	(B) January 13, 2022 (CMS-1753-CN; 87 FR 2058)
	(C) August 13, 2021 (CMS-1752-F; 86 FR 44774)
	(D) October 20, 2021 (CMS-1752-F2; 86 FR 58019)

Applicable sections of Title 42, Code of Federal Regulations	§ 419.2 (As amended; effective January 1, 2016)
	§ 419.32 (As amended; effective January 1, 2021)
	§ 419.43 (As amended; effective January 1, 2017)
	§ 419.44 (As amended; effective January 1, 2017)
	§ 419.62 (Effective January 1, 2004)
	§ 419.64 (As amended; effective January 1, 2015)
	§ 419.66 (As amended; effective January 1, 2021)
	§ 419.71 (Effective January 1, 2018)
Ambulatory Surgical Centers Payment System Addenda	For services occurring on or after March 1, 2022, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "January 2022 ASC Approved HCPCS Code and Payment Rates -- Updated 02/10/22" (January_2022_ASC_Addenda_revised_2.10.22.xlsx)

	For services occurring on or after April 1, 2022, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "April 2022 ASC Approved HCPCS Code and Payment Rates-Updated 04/6/2022" (April_2022_ASC_Addenda_revised.04062022.xlsx)

	For services occurring on or after July 1, 2022 Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "July 2022 ASC Approved HCPCS Code and Payment Rates" (July_2022_ASC_Addenda.063022.xlsx)

	For services occurring on or after October 1, 2022, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "October 2022 ASC Approved HCPCS Code and Payment Rates-Updated 10/18/2022" (October_2022_ASC_Addenda.10172022.xlsx)

	Note:

	Access the files on CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates

APC Payment Rate	For services occurring on or after March 1, 2022, Addendum B-Correction dated January 10, 2022, (January_2022_OPPS_Web_Addendum_B.01.10.22.xlsx)

	For services occurring on or after April 1, 2022, Addendum B April 2022-updated 4/6/2022, (April_2022_Web_Addendum_B.04052022.xlsx)

	For services occurring on or after July 1, 2022, Addendum B dated June 22, 2022, (July_2022_Web_Addendum_B.062222.xlsx)

	For services occurring on or after October 1, 2022, Addendum B October 2022-updated 11/14/2022, (October_2022_Web_Addendum_B.11142022.xlsx)

APC Relative Weight	For services occurring on or after March 1, 2022, Addendum B-Correction dated January 10, 2022 (January_2022_OPPS_Web_Addendum_B.01.10.22.xlsx)

	For services occurring on or after April 1, 2022, Addendum B April 2022-updated 4/6/2022, (April_2022_Web_Addendum_B.04052022.xlsx)

	For services occurring on or after July 1, 2022, Addendum B dated June 22, 2022, (July_2022_Web_Addendum_B.062222.xlsx)

	For services occurring on or after October 1, 2022, Addendum B October 2022-updated 11/14/2022, (October_2022_Web_Addendum_B.11142022.xlsx)
Composite APCs (codes assigned status indicator "Q1," "Q2," "Q3," or "Q4") payment rules	For services occurring on or after March 1, 2022, payment rules are:

	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2022 OPPS Addendum D1 (2021 NFRM OPPS Addendum D1.11012021.xlsx)
	* CMS 2022 OPPS Addendum M
	* IOCE Quarterly Data Files V23.R0 [ZIP, 27.3MB] IntegOCEspecs_V23.0_Jan.22.pdf, sections 5.4.1, 5.4.3, 5.4.5, and 5.5

	For services occurring on or after April 1, 2022, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2022 OPPS Addendum D1 (2022 NFRM OPPS Addendum D1.11012021.xlsx)
	* CMS 2022 OPPS Addendum M
	* IOCE Quarterly Data IOCE Quarterly Data Files V231.R0 April 2022 [ZIP, 26.9MB], IntegOCEspecs_V23.1_Apr22.pdf, sections 5.4.1, 5.4.3, 5.4.5, and 5.5

	For services occurring on or after July 1, 2022, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2022 OPPS Addendum D1 (2022 NFRM OPPS Addendum D1.11012021.xlsx)
	* CMS 2022 OPPS Addendum M
	* IOCE Quarterly Data IOCE Quarterly Data Files V232.R0 July 2022 [ZIP, 25.7MB], IntegOCEspecs_V23.2_Jul22.pdf, sections 5.4.1, 5.4.3, 5.4.5, and 5.5

	For services occurring on or after October 1, 2022, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2022 OPPS Addendum D1 (2022 NFRM OPPS Addendum D1.11012021.xlsx)
	* CMS 2022 OPPS Addendum M
	* IOCE Quarterly Data IOCE Quarterly Data Files V233.R0 October 2022 [ZIP, 25.9MB], IntegOCEspecs_V23.3_Oct22.pdf, sections 5.3.1, 5.3.3, 5.3.5, and 5.4

	Access documents on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html?redirect=/HospitalOutpatientPPS/ and CMS Claims Processing Manual at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html

Comprehensive APCs (codes assigned status indicator "J1" or "J2") payment rules	For services occurring on or after March 1, 2022, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.4, 290.5.2, and 290.5.3
	* CMS 2022 OPPS Addendum D1
	* CMS 2022 OPPS Addendum J
	* IOCE Quarterly Data Files V23.R0 [ZIP, 27.3MB] IntegOCEspecs_V23.0_Jan.22.pdf, sections 5.6.1, 5.6.1.1, 5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

	For services occurring on or after April 1, 2022, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.2.4, 10.4, 290.5.2, and 290.5.3
	* CMS 2022 OPPS Addendum D1 (2022 NFRM OPPS Addendum D1.11012021.xlsx)
	* CMS 2022 OPPS Addendum J
	* IOCE Quarterly Data IOCE Quarterly Data Files V231.R0 April 2022 [ZIP, 26.9MB], IntegOCEspecs_V23.1_Apr22.pdf, sections 5.6.1, 5.6.1.1, 5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

	For services occurring on or after July 1, 2022, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.2.4, 10.4, 290.5.2, and 290.5.3
	* CMS 2022 OPPS Addendum D1 (2022 NFRM OPPS Addendum D1.11012021.xlsx)
	* CMS 2022 OPPS Addendum J
	* IOCE Quarterly Data IOCE Quarterly Data Files V232.R0 July 2022 [ZIP, 25.7MB], IntegOCEspecs_V23.2_Jul22.pdf, sections 5.6.1, 5.6.1.1, 5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

	For services occurring on or after October 1, 2022, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.2.4, 10.4, 290.5.2, and 290.5.3
	* CMS 2022 OPPS Addendum D1 (2022 NFRM OPPS Addendum D1.11012021.xlsx)
	* CMS 2022 OPPS Addendum J
	* IOCE Quarterly Data IOCE Quarterly Data Files V233.R0 October 2022 [ZIP, 25.9MB], IntegOCEspecs_V23.3_Oct22.pdf, sections 5.5.1, 5.5.1.1, 5.5.2, 5.5.3.1, 5.5.4, 5.5.4.1, and 5.5.4.2

	Access documents on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html
	And CMS Claims Processing Manual at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending

Emergency Department HCPCS Codes	99281-99285, 99291, 99292, G0380-G0384, G0390

Facility Only Services	Not applicable for services rendered on or after December 15, 2016

Film X-ray services and X-rays taken using computed radiography technology/cassette-based imaging payment reductions	Use modifier "FX" to report X-rays taken using film, which requires a 20 percent payment reduction for such service. Use modifier "FY" to report X-rays taken using computed radiography technology/cassette-based imaging which requires a 7 percent payment reduction for such service. Apply payment rules set forth in:
	* December 14, 2017 (CMS-1678-FC; 82 FR 59216, Republished, section X.E., pages 59391 through 59393)
	* Medicare Claims Processing Manual, Chapter 4, section 20.6.14 (effective 01/01/2018) and section 20.6.15 (effective 01/01/2018)
	* CFR section 419.71
	* CMS' April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) CR 10515 Revised March 22, 2018, Transmittal R4005CP, section 6

	Access the Medicare Claims Processing Manual on the CMS website at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-ltems/CMS018912.html

HOPPS Addenda	For services occurring on or after March 1, 2022 addenda:
	* A (January 2022-Correction; January_2022_OPPS_Web_Addendum_A.01.10.22.xlsx)
	* B (January 2022-Correction; January_2022_OPPS_Web_Addendum_B.01.10.22.xlsx)
	* D1 (2022 NFRM OPPS Addenda; 2022 NFRM Addendum D1.11012022.xlsx)
	* D2 (2022 NFRM OPPS Addenda; 2022 NFRM Addendum D2.11012022.xlsm)
	* E (2022 NFRM OPPS Addenda; 2022 NFRM Addendum E.11012022.xlsx)
	* J (2022 NFRM OPPS Addenda; 2022 NFRM Addendum J.11012022.xls)
	* L (2022 NFRM OPPS Addenda; 2022 NFRM Addendum L.11012022.xlsx)
	* M (2022 NFRM OPPS Addenda; 2022 NFRM Addendum M.11012022.xlsx)
	* P (2022 CN Addendum P; 2022 CN Addendum P.01142022.xlsx)

	For services rendered on or after April 1, 2022:
	* A (April 2022-Correction; April_2022_Web_Addendum_A.04062022.xlsx)
	* B (April 2022-Correction; April_2022_Web_Addendum_B.04062022.xlsx)
	* D1 (2022 NFRM OPPS Addenda; 2022 NFRM Addendum D1.11012022.xlsx)
	* D2 (2022 NFRM OPPS Addenda; 2022 NFRM Addendum D2.11012022.xlsm)
	* E (2022 NFRM OPPS Addenda; 2022 NFRM Addendum E.11012022.xlsx)
	* J (2022 NFRM OPPS Addenda; 2022 NFRM Addendum J.11012022.xls)
	* L (2022 NFRM OPPS Addenda; 2022 NFRM Addendum L.11012022.xlsx)
	* M (2022 NFRM OPPS Addenda; 2022 NFRM Addendum M.11012022.xlsx)
	* P (2022 CN Addendum P; 2022 CN Addendum P.01142022.xlsx)

	For services occurring on or July 1, 2022 addenda:
	* A (July 2022; July 2022 Web Addendum_A.062222.xlsx)
	* B (July 2022; July 2022 Web Addendum_B.062222.xlsx)
	* D1 (2022 NFRM OPPS Addenda; 2022 NFRM Addendum D1.11012021.xlsx)
	* D2 (2022 NFRM OPPS Addenda; 2022 NFRM Addendum D2.11012021.xlsm)
	* E (2022 NFRM OPPS Addenda; 2022 NFRM Addendum E.11012021.xlsx)
	* J (2022 NFRM OPPS Addenda; 2022 NFRM Addendum J.11012021.xls)
	* L (2022 NFRM OPPS Addenda; 2022 NFRM Addendum L.11012021.xlsx)
	* M (2022 NFRM OPPS Addenda; 2022 NFRM Addendum M.11012021.xlsx)
	* P (2022 CN Addendum P; 2022 CN Addendum P.01142022.xlsx)

	For services occurring on or after October 1, 2022 addenda:
	* A (October 2022-updated; October_2022_Web_Addendum_A.11142022.xlsx)
	* B (October 2022-updated; October_2022_Web_Addendum_B.11142022.xlsx)
	* D1 (2022 NFRM OPPS Addenda; 2022 NFRM Addendum D1.11012021.xlsx)
	* D2 (2022 NFRM OPPS Addenda; 2022 NFRM Addendum D2.11012021.xlsm)
	* E (2022 NFRM OPPS Addenda; 2022 NFRM Addendum E.11012021.xlsx)
	* J (2022 NFRM OPPS Addenda; 2022 NFRM Addendum J.11012021.xls)
	* L (2022 NFRM OPPS Addenda; 2022 NFRM Addendum L.1101201.xlsx)
	* M (2022 NFRM OPPS Addenda; 2022 NFRM Addendum M.11012021.xlsx)
	* P (2022 CN Addendum P; 2022 CN Addendum P.01142022.xlsx)

	Note:
	Access the files on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html

IPPS Tables	FY 2022 Tables 2, 3, and 4A and 4B (Wage Index Tables) (Final Rule, Correction and Correcting Amendment,) [ZIP, 1.2MB] found at https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page

Labor-related Share	60% (A) at page 63,500

Market Basket Inflation Factor	2.7% (A) at page 63,500

Medicare Physician Fee Schedule Relative Value File	Not applicable for services rendered on or after December 15, 2016

Surgical Procedure HCPCS	For services rendered on or after March 1, 2022, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "CY 2022 CN ASC AA," Column A, of CMS' ASC "CY 2022 CN ASC EE, and CPT codes 15772, 15774, 15999, 17999, 19499, 20560, 20561, 20700-20705, 20999, 21089, 21299, 21499, 21811-21813, 21899, 22634, 22899, 22999, 23929, 24999, 25999, 26989, 27299, 27599, 27899, 28899, 29799, 29999, 30999, 31299, 31599, 31899, 32999, 33289, 33370, 33999, 35500, 35685, 35686, 36299, 36415, 36456, 37501, 37799, 38129, 38589, 38999, 40799, 40899, 41599, 41899, 42299, 42699, 42999, 43289, 43499, 43659, 43999, 44238, 44799, 44979, 45399, 45499, 45999, 46999, 47379, 47399, 47579, 47999, 48999, 49329, 49659, 49999, 50549, 50949, 51999, 53899, 54699, 55559, 55899, 57465, 58578, 58579, 58679, 58999, 60659, 60699, 63502, 63503, 64629, 64999, 66999, 67299, 67399, 67599, 67999, 68399, 68841, 68899, 69399, 69799, 69949, and 69979 but, excluding HCPCS codes listed on CMS' 2022 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "January 2022 ASC Approved HCPCS Code and Payment Rates -- Updated 02/10/2022" (January_2022_ASC_Addenda_revised_2.10.22.xlsx)

	Access the files on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates

	2022 HOPPS Addendum E (2022 NFRM Addendum E.11012022.xlsx) is found at: https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientpps/cms-1753-fc

	For services rendered on or after April 1, 2022, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "Apr 2022 ASC AA," Column A, of CMS' ASC "Apr 2022 ASC EE," and CPT codes 15772, 15774, 15999, 17999, 19499, 20560, 20561, 20700-20705, 20999, 21089, 21299, 21499, 21811-21813, 21899, 22634, 22899, 22999, 23929, 24999, 25999, 26989, 27299, 27599, 27899, 28899, 29799, 29999, 30999, 31299, 31599, 31899, 32999, 33289, 33370, 33999, 35500, 35685, 35686, 36299, 36415, 36456, 37501, 37799, 38129, 38589, 38999, 40799, 40899, 41599, 41899, 42299, 42699, 42999, 43289, 43499, 43659, 43999, 44238, 44799, 44979, 45399, 45499, 45999, 46999, 47379, 47399, 47579, 47999, 48999, 49329, 49659, 49999, 50549, 50949, 51999, 53899, 54699, 55559, 55899, 57465, 58578, 58579, 58679, 58999, 60659, 60699, 63502, 63503, 64629, 64999, 66999, 67299, 67399, 67599, 67999, 68399, 68841, 68899, 69399, 69799, 69949, and 69979 but, excluding HCPCS codes listed on CMS' 2022 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "April 2022 ASC Approved HCPCS Code and Payment Rates-Updated 04/06/22" (April_2022_ASC_Addenda.04062022.xlsx)

	2022 HOPPS Addendum E (2022 NFRM Addendum E.11012021.xlsx) is found at: https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientpps/cms-1753-fc

	For services rendered on or after July 1, 2022, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "July 2022 ASC AA," Column A, of CMS' ASC "July 2022 ASC EE", and CPT codes 15772, 15774, 15999, 17999, 19499, 20560, 20561, 20700-20705, 20999, 21089, 21299, 21499, 21811-21813, 21899, 22634, 22899, 22999, 23929, 24999, 25999, 26989, 27299, 27599, 27899, 28899, 29799, 29999, 30999, 31299, 31599, 31899, 32999, 33289, 33370, 33999, 35500, 35685, 35686, 36299, 36415, 36456, 37501, 37799, 38129, 38589, 38999, 40799, 40899, 41599, 41899, 42299, 42699, 42999, 43289, 43499, 43659, 43999, 44238, 44799, 44979, 45399, 45499, 45999, 46999, 47379, 47399, 47579, 47999, 48999, 49329, 49659, 49999, 50549, 50949, 51999, 53899, 54699, 55559, 55899, 57465, 58578, 58579, 58679, 58999, 60659, 60699, 63502, 63503, 64629, 64999, 66999, 67299, 67399, 67599, 67999, 68399, 68841, 68899, 69399, 69799, 69949, and 69979 but, excluding HCPCS codes listed on CMS' 2022 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "July 2022 ASC Approved HCPCS Code and Payment Rates" (July_2022_ASC_Addenda.063022.xlsx)

	Access the files on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates

	2022 HOPPS Addendum E (2022 NFRM Addendum E.11012021.xlsx) is found at: https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientpps/cms-1753-fc

	For services rendered on or after October 1, 2022, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "Oct 2022 ASC AA," Column A, of CMS' ASC "Oct 2022 ASC EE", and CPT codes 15772, 15774, 15999, 17999, 19499, 20560, 20561, 20700-20705, 20999, 21089, 21299, 21499, 21811-21813, 21899, 22634, 22899, 22999, 23929, 24999, 25999, 26989, 27299, 27599, 27899, 28899, 29799, 29999, 30999, 31299, 31599, 31899, 32999, 33289, 33370, 33999, 35500, 35685, 35686, 36299, 36415, 36456, 37501, 37799, 38129, 38589, 38999, 40799, 40899, 41599, 41899, 42299, 42699, 42999, 43289, 43499, 43659, 43999, 44238, 44799, 44979, 45399, 45499, 45999, 46999, 47379, 47399, 47579, 47999, 48999, 49329, 49659, 49999, 50549, 50949, 51999, 53899, 54699, 55559, 55899, 57465, 58578, 58579, 58679, 58999, 60659, 60699, 63502, 63503, 64629, 64999, 66999, 67299, 67399, 67599, 67999, 68399, 68841, 68899, 69399, 69799, 69949, and 69979 but, excluding HCPCS codes listed on CMS' 2022 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "October 2022 ASC Approved HCPCS Code and Payment Rates-Updated 10/18/2022" (October_2022_ASC_Addenda.10172022.xlsx)

	Access the files on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates

Conversion Factor adjusted for inflation factor	$ 89.845 (2021 unadjusted conversion factor of $87.483 x estimated inflation factor of 1.027)

Wage Index	Referenced in (A) beginning at page 63503; wage index values are specified in Table 2 (C) and (D) found on the CMS website at: https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page

	*Services Occurring On or After March 1, 2023 and Mid-year Updates*

Applicable FR Notices	(A) November 23, 2022 (CMS-1772-FC; 87 FR 71748);
	(B) August 10, 2022 (CMS-1771-F; 87 FR 48780 final rule)
	(C) November 4, 2022 (CMS-1771-F2; 87 FR 66558; correcting amendment)
	(D) December 13, 2022 (CMS-1771-CN; 87 FR 76109)

Applicable sections of Title 42, Code of Federal Regulations	§ 419.2 (As amended; effective January 1, 2016)
	§ 419.32 (As amended; effective January 1, 2021)
	§ 419.43 (As amended; effective January 1, 2023)
	§ 419.44 (As amended; effective January 1, 2017)
	§ 419.62 (Effective January 1, 2004)
	§ 419.64 (As amended; effective January 1, 2015)
	§ 419.66 (As amended; effective January 1, 2021)
	§ 419.71 (Effective January 1, 2018)

Ambulatory Surgical Centers Payment System Addenda	For services occurring on or after March 1, 2023, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "January 2023 ASC Approved HCPCS Code and Payment Rates -- Updated 01/09/2023" (2023_January_ASC_Addenda_revised_01092023.xlsx)

	For services occurring on or after May 1, 2023 Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "April 2023 ASC Approved HCPCS Code and Payment Rates -- Updated 04/03/2023" (April_2023_ASC_Addenda_04032023.xlsx)

	For services occurring on or after July 1, 2023 Column A, of Addendum AA entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "July 2023 ASC Approved HCPCS Code and Payment Rates -- Updated 06/29/2023" (July_2023_ASC_Addenda_06292023.xlsx)

	For services occurring on or after October 1, 2023 Column A, of Addendum AA entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "October 2023 ASC Approved HCPCS Code and Payment Rates -- Updated 09/22/2023" (October_2023_ASC_Addenda.09212023rev.xlsx)

	Note:

	Access the files on CMS website at: https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-payment-rates-addenda

APC Payment Rate	For services occurring on or after March 1, 2023, January 2023 Addendum B (2023_Web_Addendum_B.01202023a.xlsx)

	For services occurring on or after May 1, 2023, Addendum B April 2023 -- updated 05/10/2023, (2023_April_Web_Addendum_B.05102023.xlsx)

	For services occurring on or after July 1, 2023, Addendum B July 2023 -- updated 08/01/2023, (2023_July_Web_Addendum_B.08012023.xlsx)

	For services occurring on or after October 1, 2023, Addendum B October 2023, (2023_Web_October_Addendum_B.09192023.xlsx)

APC Relative Weight	For services occurring on or after March 1, 2023, January 2023 Addendum B (2023_Web_Addendum_B.01202023a.xlsx)

	For services occurring on or after May 1, 2023, Addendum B April 20223 -- updated 05/10/2023, (2023_April_Web_Addendum_B.05102023.xlsx)

	For services occurring on or after July 1, 2023, Addendum B July 2023 -- updated 08/01/2023, (2023_July_Web_Addendum_B.08012023.xlsx)

	For services occurring on or after October 1, 2023, Addendum B October 2023 (2023_Web_October_Addendum_B.09192023.xlsx)

Composite APCs (codes assigned status indicator "Q1," "Q2," "Q3," or "Q4") payment rules	For services occurring on or after March 1, 2023, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2023 OPPS Addendum D1 (2023 NFRM OPPS Addendum D1.11012022.xlsx)
	* CMS 2023 OPPS Addendum M
	* IOCE Quarterly Data Files V240.R1 [ZIP, 27.6MB] IntegOCEspecs_V24.0_Jan.23.pdf, sections 5.3.1, 5.3.3, 5.3.5, and 5.4

	For services occurring on or after May 1, 2023, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2023 OPPS Addendum D1 (2023 NFRM OPPS Addendum D1.11012022.xlsx)
	* CMS 2023 OPPS Addendum M
	* IOCE Quarterly Data IOCE Quarterly Data Files V241.R0 April 2023 [ZIP, 26.2MB], IntegOCEspecs_V24.1_Apr23.pdf, sections 5.3.1, 5.3.3, 5.3.5 and 5.4

	For services occurring on or after July 1, 2023, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2023 OPPS Addendum D1 (2023 NFRM OPPS Addendum D1.11012022.xlsx)
	* CMS 2023 OPPS Addendum M
	* IOCE Quarterly Data IOCE Quarterly Data Files V242.R0 July 2023 [ZIP, 27.1MB], IntegOCEspecs_V24.2_Jul23.pdf, sections 5.4.1, 5.4.3, 5.4.5 and 5.5

	For services occurring on or after October 1, 2023, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2023 OPPS Addendum D1 (2023 NFRM OPPS Addendum D1.11012022.xlsx)
	* CMS 2023 OPPS Addendum M
	* IOCE Quarterly Data IOCE Quarterly Data Files V243.R0 October 2023 [ZIP, 24.9MB], IntegOCEspecs_V24.3_Oct23.pdf, sections 5.4.1, 5.4.3, 5.4.5 and 5.5

	Note:
	A link to the IOCE is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm#6

	Access documents on the CMS website at: https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1772-fc and CMS Claims Processing Manual at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html

Comprehensive APCs (codes assigned status indicator "J1" or "J2") payment rules	For services occurring on or after March 1, 2023, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.4, 290.5.2, and 290.5.3
	* CMS 2023 OPPS Addendum D1
	* CMS 2023 OPPS Addendum J
	* IOCE Quarterly Data Files V240.R1 [ZIP, 27.6MB] IntegOCEspecs_V24.0_Jan.23.pdf, sections 5.5.1, 5.5.1.1, 5.5.2, 5.5.3, 5.5.4, 5.5.4.1, and 5.5.4.2

	For services occurring on or after May 1, 2023, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.4, 290.5.2, and 290.5.3
	* CMS 2023 OPPS Addendum D1
	* CMS 2023 OPPS Addendum J
	* IOCE Quarterly Data IOCE Quarterly Data Files V241.R0 April 2023 [ZIP, 26.2MB], IntegOCEspecs_V24.1_Apr23.pdf, sections 5.5.1, 5.5.1.1, 5.5.2, 5.5.3, 5.5.4, 5.5.4.1, and 5.5.4.2

	For services occurring on or after July 1, 2023, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.4, 290.5.2, and 290.5.3
	* CMS 2023 OPPS Addendum D1
	* CMS 2023 OPPS Addendum J
	* IOCE Quarterly Data IOCE Quarterly Data Files V242.R0 July 2023 [ZIP, 27.1MB], IntegOCEspecs_V24.2_Jul23.pdf, sections 5.6.1, 5.6.1.1, 5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

	For services occurring on or after October 1, 2023, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.4, 290.5.2, and 290.5.3
	* CMS 2023 OPPS Addendum D1
	* CMS 2023 OPPS Addendum J
	* IOCE Quarterly Data IOCE Quarterly Data Files V243.R0 October 2023 [ZIP, 24.9MB], IntegOCEspecs_V24.3_Oct23.pdf, sections 5.6.1, 5.6.1.1, 5.6.2, 5.6.3, 5.6.4, 5.6.4.1, and 5.6.4.2

	Note:
	A link to the IOCE is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm#6

	Access documents on the CMS website at: https://www.cms.gov/medicaremedicare-fee-service-paymen-thospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1772-fc
	And CMS Claims Processing Manual at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html

Emergency Department HCPCS Codes	99281-99285, 99291, 99292, G0380-G0384, G0390

Facility Only Services	Not applicable for services rendered on or after December 15, 2016

Film X-ray services and X-rays taken using computed radiography technology/cassette-based imaging payment reductions	Use modifier "FX" to report X-rays taken using film, which requires a 20 percent payment reduction for such service. Use modifier "FY" to report X-rays taken using computed radiography technology/cassette-based imaging which requires a 7 percent payment reduction for such service. Apply payment rules set forth in:
	* December 14, 2017 (CMS-1678-FC; 82 FR 59216, Republished, section X.E., pages 59391 through 59393)
	* Medicare Claims Processing Manual, Chapter 4, section 20.6.14 (effective 01/01/2018) and section 20.6.15 (effective 01/01/2018)
	* CFR section 419.71
	* CMS' April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) CR 10515 Revised March 22, 2018, Transmittal R4005CP, section 6

	Access the Medicare Claims Processing Manual on the CMS website at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-ltems/CMS018912.html

HOPPS Addenda	For services occurring on or after March 1, 2023 addenda:
	* A (January 2023 -- Correction; 2023_January_Web_Addendum_A.01202023a.xlsx)
	* B (January 2023 -- Correction; 2023_January_Web_Addendum_B.01202023a.xlsx)
	* D1 (2023 NFRM OPPS Addenda; 2023 NFRM Addendum D1.11012022.xlsx)
	* D2 (2023 NFRM OPPS Addenda; 2023 NFRM Addendum D2.11012022.xlsm)
	* E (2023 NFRM OPPS Addenda; 2023 NFRM Addendum E.11012022.xlsx)
	* J (2023 NFRM OPPS Addenda; 2023 NFRM Addendum J.11012022.xls)
	* L (2023 NFRM OPPS Addenda; 2023 NFRM Addendum L.11012022.xlsx)
	* M (2023 NFRM OPPS Addenda; 2023 NFRM Addendum M.11012022.xlsx)
	* P (2023 NFRM OPPS Addenda; 2023 NFRM Addendum P.11012022.xlsx)

	For services occurring on or after May 1, 2023 addenda:
		*	A (April 2023 -- updated 05/10/2023; 2023_April_Web_Addendum_A.05102023.xlsx)
		*	B (April 2023 -- updated 05/10/2023; 2023_April_Web_Addendum_B.05102023.xlsx)
		*	D1 (2023 NFRM OPPS Addenda; 2023 NFRM Addendum D1.11012022.xlsx)
		*	D2 (2023 NFRM OPPS Addenda; 2023 NFRM Addendum D2.11012022.xlsm)
		*	E (2023 NFRM OPPS Addenda; 2023 NFRM Addendum E.11012022.xlsx)
		*	J (2023 NFRM OPPS Addenda; 2023 NFRM Addendum J.11012022.xls)
		*	L (2023 NFRM OPPS Addenda; 2023 NFRM Addendum L.11012022.xlsx)
		*	M (2023 NFRM OPPS Addenda; 2023 NFRM Addendum M.11012022.xlsx)
		*	P (2023 NFRM OPPS Addenda; 2023 NFRM Addendum P.11012022.xlsx)

	For services occurring on or after July 1, 2023 addenda:
		*	A (July 2023 -- updated 08/01/2023; 2023_July_Web_Adddendum_A.08012023.xlsx)
		*	B (July 2023 -- updated 08/01/2023; 2023_July_Web_Addendum_B.08012023.xlsx)
		*	D1 (2023 NFRM OPPS Addenda; 2023 NFRM Addendum D1.11012022.xlsx)
		*	D2 (2023 NFRM OPPS Addenda; 2023 NFRM Addendum D2.11012022.xlsm)
		*	E (2023 NFRM OPPS Addenda; 2023 NFRM Addendum E.11012022.xlsx)
		*	J (2023 NFRM OPPS Addenda; 2023 NFRM Addendum J.11012022.xls)
		*	L (2023 NFRM OPPS Addenda; 2023 NFRM Addendum L.11012022.xlsx)
		*	M (2023 NFRM OPPS Addenda; 2023 NFRM Addendum M.11012022.xlsx)
		*	P (2023 NFRM OPPS Addenda; 2023 NFRM Addendum P.11012022.xlsx)

	For services occurring on or after October 1, 2023 addenda:
		*	A (October 2023; 2023_October_Web_Adddendum_A.09192023.xlsx)
		*	B (October 2023; 2023_October_Web_Addendum_B.09192023.xlsx)
		*	D1 (2023 NFRM OPPS Addenda; 2023 NFRM Addendum D1.11012022.xlsx)
		*	D2 (2023 NFRM OPPS Addenda; 2023 NFRM Addendum D2.11012022.xlsm)
		*	E (2023 NFRM OPPS Addenda; 2023 NFRM Addendum E.11012022.xlsx)
		*	J (2023 NFRM OPPS Addenda; 2023 NFRM Addendum J.11012022.xls)
		*	L (2023 NFRM OPPS Addenda; 2023 NFRM Addendum L11012022.xlsx)
		*	M (2023 NFRM OPPS Addenda; 2023 NFRM Addendum M.11012022.xlsx)
		*	P (2023 NFRM OPPS Addenda; 2023 NFRM Addendum P.11012022.xlsx)

	Note:
	Access the files on the CMS website at: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/addendum-a-b-updates

IPPS Tables	FY 2023 Tables 2, 3 and 4A and 4B (Wage Index Tables) (Final Rule) [ZIP, 700KB] found at https://www.cms.gov/medicare/acute-inpatient-pps/fy-2023-ipps-final-rule-home-page

Labor-related Share	60% (A) at page 71782

Market Basket Inflation Factor	4.1% (A) at page 71782

Medicare Physician Fee Schedule Relative Value File	Not applicable for services rendered on or after December 15, 2016

Surgical Procedure HCPCS	For services rendered on or after March 1, 2023, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "Jan 2023 ASC AA," Column A, of CMS' ASC "Jan 2023 ASC EE", and CPT codes 15772, 15774, 15853, 15854, 20560, 20561, 20701-20705, 21811-21813, 22634, 33289, 33370, 33904, 35500, 35685, 35686, 36415, 36456, 49623, 57465, 63052, 63053, 64629, and 68841, but, excluding HCPCS codes listed on CMS' 2023 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: January 2023 ASC Approved HCPS Code and Payment Rates -- Updated 01/09/2023 (2023_January_ASC_Addenda_updated_01092023.xlsx) on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates

	Access the files on the CMS website at: https://www.cms.gov/medicare/medicare-fee-for-service-payment/ascpayment/11_addenda_updates

	2023 HOPPS Addendum E (2023 NFRM Addendum E.11012022.xlsx) is found at: https://www.cms.gov/medicaremedicare-fee-service-paymentascpaymentasc-regulations-and-notices/cms-1772-fc

	For services rendered on or after May 1, 2023, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "Apr 2023 ASC AA," Column A, of CMS' ASC "Apr 2023 ASC EE", and CPT codes 15772, 15774, 15853, 15854, 20560, 20561, 20701-20705, 21811-21813, 22634, 33289, 33370, 33904, 35500, 35685, 35686, 36415, 36456, 49623, 57465, 63052, 63053, 64629, and 68841, but, excluding HCPCS codes listed on CMS' 2023 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "April 2023 ASC Approved HCPCS Code and Payment Rates -- Updated 04/03/23" (April_2023_ASC_Addenda_04032023.xlsx)

	Access the files on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates

	2023 HOPPS Addendum E (2023 NFRM Addendum E.11012022.xlsx) is found at: https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1772-fc

	For services rendered on or after July 1, 2023, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "July 2023 ASC AA," Column A, of CMS' ASC "July 2023 ASC EE", and CPT codes 15772, 15774, 15853, 15854, 20560, 20561, 20701-20705, 21811-21813, 22634, 33289, 33370, 33904, 35500, 35685, 35686, 36415, 36456, 49623, 57465, 63052, 63053, 64629, and 68841, but, excluding HCPCS codes listed on CMS' 2023 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "July 2023 ASC Approved HCPCS Code and Payment Rates -- Updated 06/29/23" (July_2023_ASC_Addenda_06292023.xlsx)

	Access the files on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates

	2023 HOPPS Addendum E (2023 NFRM Addendum E.11012022.xlsx) is found at: https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1772-fc

	For services rendered on or after October 1, 2023, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center Payment System (ASC) "October 2023 ASC AA," Column A, of CMS' ASC "October 2023 ASC EE", and CPT codes 15772, 15774, 15853, 15854, 20560, 20561, 20701-20705, 21811-21813, 22634, 33289, 33370, 33904, 35500, 35685, 35686, 36415, 36456, 49623, 57465, 63052, 63053, 64629, and 68841, but, excluding HCPCS codes listed on CMS' 2023 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: "October 2023 ASC Approved HCPCS Code and Payment Rates -- Updated 09/22/2023" (October_2023_ASC_Addenda_09212023rev.xlsx)

	Access the files on the CMS website at: https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-payment-rates-addenda

	2023 HOPPS Addendum E (2023 NFRM Addendum E.11012022.xlsx) is found at: https://www.cms.gov/medicaremedicare-fee-service-paymentascpaymentasc-regulations-and-notices/cms-1772-fc

Conversion Factor adjusted for inflation factor	$ 93.528 (2022 unadjusted conversion factor of $89.845 x estimated inflation factor of 1.041)

Wage Index	Referenced in (A) beginning at page 71782; wage index values are specified in Table 2(C) found on the CMS website at: https://www.cms.gov/medicare/acute-inpatient-pps/fy-2023-ipps-final-rule-home-page#FinalRule

	*Services Occurring On or After February 15, 2024 and Mid-year Updates*

Applicable FR Notices	(A) November 22, 2023 (CMS-1786-FC; 88 FR 81540);
	(B) August 28, 2023 (CMS-1785-F; 88 FR 58640 Final rule);
	(C) October 4, 2023 (CMS-1785-CN; 88 FR 68482 Correction Notice)

Applicable sections of Title 42. Code of Federal Regulations	§ 419.2 (As amended; effective January 1, 2016)
	§ 419.32 (As amended; effective January 1, 2021)
	§ 419.43 (As amended; effective January 1, 2023)
	§ 419.44 (As amended; effective January 1, 2017)
	§ 419.62 (Effective January 1, 2004)
	§ 419.64 (As amended; effective January 1, 2015)
	§ 419.66 (As amended; effective January 1, 2021)
	§ 419.71 (Effective January 1, 2018)

Ambulatory Surgical Centers Payment System Addenda	For services occurring on or after February 15, 2024, Column A, of Addendum AA, entitled, "HCPCS Code" and Column A, of Addendum EE, entitled, "HCPCS Code" located in "January 2024 ASC Approved HCPCS Code and Payment Rates -- updated 12/27/2023" "AA, BB, DD1, DD2, EE, and FF" (January_2024_ASC_Addenda.12272023.xlsx)

	Note:
	Access the files on CMS website at: https://www.cms.gov/medicare/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-payment-rates-addenda

APC Payment Rate	For services occurring on or after February 15, 2024, Addendum A and B Updates -- (January 2024 OPPS Addendum B.12212023.xlsx)
APC Relative Weight	For services occurring on or after February 15, 2024, Addendum A and B Updates -- (January 2024 OPPS Addendum B.12212023.xlsx)
Composite APCs (codes assigned status indicator "Q1," "Q2," "Q3," or "Q4") payment rules	For services occurring on or after February 15, 2024, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.1, 10.2.2, 10.4, and 10.4.1
	* CMS 2024 OPPS Addenda D1 (2024 NFRM Addendum D111012023.xlsx)
	* CMS 2024 OPPS Addendum M (2024 NFRM Addendum D111012023.xlsx)
	* IOCE Quarterly Data Files V250.R0 [ZIP, 27.5MB] IntegOCEspecs V25.0 Jan24.pdf, sections 6.4.1, 6.4.3, 6.4.5, and 6.5

	Note:
	A link to the IOCE is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm#6

	Access documents on the CMS website at: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1786-fc and CMS Claims Processing Manual at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-ltems/CMS018912.html

Comprehensive APCs (codes assigned status indicator "J1" or "J2") payment rules	For services occurring on or February 15, 2024, payment rules are:
	* Medicare Claims Processing Manual, Chapter 4, sections 10.2.3, 10.4, 290.5.2, and 290.5.3
	* CMS 2024 OPPS Addendum D1
	* CMS 2024 OPPS Addendum J
	* IOCE Quarterly Data Files V250.R0 [ZIP, 27.5MB] IntegOCEspecs V25.0 Jan24.pdf, sections 6.6.1, 6.6.1.1, 6.6.2, 6.6.3, 6.6.4, 6.6.4.1, and 6.6.4.2

	Note:
	A link to the IOCE is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm#6

	Access documents on the CMS website at: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulatlations-notices/cms-1786-fc and CMS Claims Processing Manual at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-ltems/CMS018912.html

Emergency Department HCPCS Codes	99281-99285, 99291, 99292, G0380-G0384, G0390

Facility Only Services	Not applicable for services rendered on or after December 15, 2016

Film X-ray services and X-rays taken using computed radiography technology/cassette-based imaging payment reductions	Use modifier "FX" to report X-rays taken using film, which requires a 20 percent payment reduction for such service. Use modifier "FY" to report X-rays taken using computed radiography technology/cassette-based imaging which requires a 7 percent payment reduction for such service. Apply payment rules set forth in:
	* December 14, 2017 (CMS-1678-FC; 82 FR 59216, Republished, section X.E., pages 59391 through 59393)
	* Medicare Claims Processing Manual, Chapter 4, section 20.6.14 (effective 01/01/2018) and section 20.6.15 (effective 01/01/2018)
	* CFR section 419.71
	* CMS' April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) CR 10515 Revised March 22, 2018, Transmittal R4005CP, section 6

	Access the Medicare Claims Processing Manual on the CMS website at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-ltems/CMS018912.html

HOPPS Addenda	For services occurring on or February 15, 2024 addenda:
		*	A (Addendum A and B Updates; January_2024_OPPS_Addendum_A.12262023.xlsx)
		*	B (Addendum A and B Updates; January_2024_OPPS_Addendum_B.12212023.xlsx)
		*	D1 (2024 NFRM OPPS Addenda; 2024 NFRM Addendum D1.11012023.xlsx)
		*	D2 (2024 NFRM OPPS Addenda; 2024 NFRM Addendum D2.11012023.xlsm)
		*	E (2024 NFRM OPPS Addenda; 2024 NFRM Addendum E.11012023.xlsx)
		*	J (2024 NFRM OPPS Addenda; 2024 NFRM Addendum J.11012023.xls)
		*	L (2024 NFRM OPPS Addenda; 2024 NFRM Addendum L.11012023.xlsx)
		*	M (2024 NFRM OPPS Addenda; 2024 NFRM Addendum M.11012023.xlsx)
		*	P (2024 NFRM OPPS Addenda; 2024 NFRM Addendum P.11012023.xlsx)

	Note:
	Access the files on the CMS website at: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notice/cms-1786-fc

IPPS Tables	FY 2024 Tables 2, 3 and 4A and 4B (Wage Index Tables) (Final Rule and Correction Notice) [ZIP, 1.31MB] found at https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page#CMS1785F

Labor-related Share	60% at (A) page (81583)

Market Basket Inflation Factor	3.3% at (A) page (81543)

Medicare Physician Fee Schedule Relative Value File	Not applicable for services rendered on or after December 15, 2016

Surgical Procedure HCPCS	For services rendered on or after February 15, 2024, HCPCS codes listed in column A, of CMS' Ambulatory Surgical Center (ASC) Payment System "CY 2024 ASC AA," Column A, of CMS' ASC "CY 2024 ASC EE", and CPT codes 15772, 15774, 15853, 15854, 20560, 20561, 20701-20705, 21811-21813, 22634, 33370, 33904, 35500, 35685, 35686, 36415, 36456, 49623, 57465, 63052, 63053, and 64629, but excluding HCPCS codes listed on CMS' 2024 HOPPS Addendum E as an inpatient only procedure.

	ASC Addenda AA and EE may be found in: January 2024 ASC Approved HCPCS Code and Payment Rates -- updated 12/27/2023 (January_2024_ASC_Addenda.12272023.xlsx) on the CMS website at: https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-payment-rates-addenda

	2024 HOPPS Addendum E (2024 NFRM Addendum E.11012023.xlsx) is found at: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1786-fc

Conversion Factor adjusted for inflation factor	$ 96.614 (2023 unadjusted conversion factor of $93.528 x estimated inflation factor of 1.033)

Wage Index	Referenced in (A) beginning at page 81583; wage index values are specified in Table 2(B) and (C) found on the CMS website at: https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page

Cal. Code Regs. Tit. 8, § 9789.39

Note: Authority cited: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 4603.2 and 5307.1, Labor Code.

1. New section filed 12-27-2012; operative 1-1-2013 as a file and print only pursuant to Government Code section 11340.9(g) (Register 2012, No. 52).
2. Amendment filed 3-29-2013; operative 4-1-2013 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2013, No. 13).
3. Amendment of section heading and section filed 6-3-2014; operative 9-1-2014 as a file and print only pursuant to Government Code section 11340.9(g) (Register 2014, No. 23).
4. Amendment filed 12-4-2014; operative 12/1/2014 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2014, No. 49).
5. Amendment filed 12-15-2016; operative 12/15/2016 as a file and print only pursuant to Government Code section 11340.9(g) (Register 2016, No. 51).
6. Editorial correction of subsection (b) (Register 2017, No. 18).
7. Amendment filed 6-20-2017; operative 6/1/2017 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2017, No. 25).
8. Amendment filed 5-8-2018; operative 3/15/2018 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2018, No. 19).
9. Editorial correction (Register 2019, No. 5).
10. Amendment filed 2-14-2019; operative 2/15/2019 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2019, No. 7).
11. Editorial correction (Register 2019, No. 33).
12. Amendment of subsection (b) filed 3-19-2020; operative 3/1/2020 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2020, No. 12).
13. Amendment filed 4-1-2021; operative 3/1/2021 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2021, No. 14).
14. Amendment of subsection (b) filed 4-5-2022; operative 3/1/2022 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2022, No. 14).
15. Amendment of subsection (b) filed 3-1-2023; operative 3/1/2023 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2023, No. 9).
16. Amendment of subsection (b) filed 3-12-2024; operative 2/15/2024 pursuant to Labor Code section 5307.1(g)(2). Exempt from the APA pursuant to Labor Code section 5307.1(g)(2) and submitted to OAL for filing and printing only pursuant to Government Code section 11343.8 (Register 2024, No. 11).