/ en Sun, 10 Aug 2025 05:31:30 -0500 Fri, 08 Aug 25 11:21:57 -0500 /dataset/2025-08-08-hpa-opps-rate-comparison-tables-2026 <p>Below are three spreadsheets, one comparing relative weights and payment rates at the APC level, using the 2026 proposed rule Addendum A compared to 2025 Addendum A (July 1, 2025 file), as downloaded from the CMS website. The second spreadsheet makes similar comparisons at the HCPCS level, using proposed rule Addendum B compared to 2025 Addendum B (July 1 2025 file).  Spreadsheet cells highlighted in yellow were calculated by HPA; all other information is from CMS. The third spreadsheet is an OPPS APC/HCPCS lookup tool that allows the user to pull-up basic descriptive and payment information for a code.</p><p>The Addendum A spreadsheet contains these 5 tabs:</p><ul><li><u>2026 NPRM Add. A by APC</u>: compares 2025 and proposed 2026 status indicators, relative weights, and payment rates for all APCs in APC order</li><li><u>2026 NPRM Add. A sorted</u>: same as previous tab but sorted by percent change in payment rate, from largest percentage loss to biggest percentage gain</li><li><u>2026 NPRM New Proposed APCs</u>: displays the new APCs</li><li><u>2026 NPRM Deleted APCs: displays the APCs deleted from 2025 NPRM Deleted</u></li><li><u>2026 Status Indicators</u>:  as supplied by CMS, ADDENDUM D1.--PROPOSED OPPS PAYMENT STATUS INDICATORS FOR CY 2026</li></ul><p>The Addendum B spreadsheet contains these 7 tabs:</p><ul><li>­ <u>2026 NPRM Add. B by HCPCS</u>: compares 2025 and proposed 2026 status indicators, relative weights, and payment rates for <u>all</u> HCPCS codes included in proposed Addendum B; sorted by HCPCS code</li><li>­ <u>2026 NPRM Add. B by APC</u>: same as previous tab but sorted by APC and within APC by HCPCS code</li><li><u>Status codes G and K</u>: comparisons for separately payable drugs and biologicals with status indicator G or K in the 2026 proposed rule are shown in this tab</li><li><u>2026 NPRM Add. M</u>:  as supplied by CMS, Proposed HCPCS Codes for Assignment to Composite APCs for CY 2025</li><li><u>2026 NPRM Add. O</u>: as supplied by CMS, New CPT and G - Codes Effective January 1, 2026; CMS request comments on OPPS status indicator and APC assignments and ASC payment indicator.</li><li>­<u>2026 Status Indicators</u>:  as supplied by CMS, ADDENDUM D1.--PROPOSED OPPS PAYMENT STATUS INDICATORS FOR CY 2026</li><li>­<u>2026 Comment Indicators</u>:  as supplied by CMS, ADDENDUM D2.—PROPOSED OPPS COMMENT INDICATORS FOR CY 2026</li></ul><p>The OPPS APC/HCPCS lookup tool spreadsheet contains the following tabs:</p><ul><li>­<u>APC Lookup</u>: Allows user to lookup descriptive and payment information on a given APC. User chooses APC or types in APC in formula bar in cell “B2”. Spreadsheet automatically displays the information and the associated HCPCS that belong to that APC. Cells are locked but content can be copied and pasted into another spreadsheet for manipulation.</li><li><u>HCPCS Lookup</u>: Allows user to lookup descriptive and payment information on a given HCPCS. User chooses HCPCS or types in HCPCS in formula bar in cell “B2”. Spreadsheet automatically displays information and its associated APC.</li><li>­<u>2026 Status Indicators</u>:  as supplied by CMS, ADDENDUM D1. PROPOSED OPPS PAYMENT STATUS INDICATORS FOR CY 2026</li></ul><p class="text-align-center"><span><strong>Download the spreadsheets:</strong></span></p><p><a href="/system/files/media/file/2025/08/addendum-a-proposed-opps-payment-by-apc-for-cy-2026.xlsx" target="_blank" title="Addendum A.-Proposed OPPS Payment by APC for CY 2026"><span><strong>Addendum A.-Proposed OPPS Payment by APC for CY 2026</strong></span></a></p><p><a href="/system/files/media/file/2025/08/comparison-of-proposed-2026-opps-addendum-b-with-july-2025-addendum-b.xlsx" target="_blank" title="Comparison of Proposed 2026 OPPS Addendum B With July 2025 Addendum B"><strong>Comparison of Proposed 2026 OPPS Addendum B With July 2025 Addendum B</strong></a></p><p><a href="/system/files/media/file/2025/08/2026-nprm-opps-lookup.xlsx" target="_blank" title="2026 NPRM OPPS Lookup"><strong>2026 NPRM OPPS Lookup</strong></a></p> Fri, 08 Aug 2025 11:21:57 -0500 Dataset /2025-01-06-hpa-opps-rate-comparison-tables-2025 <div class="container"><div class="row"><div class="col-md-8"><p>Below are three spreadsheets, one comparing relative weights and payment rates at the APC level, using the most recent 2025 and 2024 Addendum A spreadsheets, as downloaded from the CMS website. The second spreadsheet makes similar comparisons at the HCPCS level.  The 2025 files are from the 2025 contractor file, dated 1-02-2025 (these are rates for January 1, 2025 through December 31, 2025). The 2024 rates are from the October Addendum contractor files –dated October 2, 2024. The third spreadsheet is an OPPS APC/HCPCS lookup tool that allows the user to pull-up basic descriptive and payment information for a code.</p><p><strong>The Addendum A spreadsheet contains these 5 tab</strong>s:</p><ul><li><u>2025 Add. A by APC</u>: compares 2024 and 2025 status indicators, relative weights, and payment rates for all APCs in APC order</li><li><u>2025 Add. A sorted</u>: same as previous tab but sorted by percent change in payment rate, from largest percentage loss to biggest percentage gain</li><li><u>2025 New APCs</u>: displays the new APCs</li><li><u>2025 Deleted APCs: displays the APCs deleted from 2025</u></li><li><u>2025 Status Indicators</u>:  as supplied by CMS, ADDENDUM D1.--OPPS PAYMENT STATUS INDICATORS FOR CY 2025</li></ul><p><strong>The Addendum B spreadsheet contains these 6 tabs:</strong></p><ul><li>­ <u>2025 Add. B by HCPCS</u>: compares 2024 and 2025 status indicators, relative weights, and payment rates for <u>all</u> HCPCS codes included in Addendum B; sorted by HCPCS code</li><li>­ <u>2025 Add. B by APC</u>: same as previous tab but sorted by APC and within APC by HCPCS code</li><li>­ <u>Status codes G and K</u>: comparisons for separately payable drugs and biologicals with status indicator G or K in the 2025 final rule are shown in this tab</li><li><u>2025 Add. M</u>:  as supplied by CMS, HCPCS Codes for Assignment to Composite APCs for CY 2025</li><li><u>2025 Add. O</u>: as supplied by CMS, New CY 2023 Category I and III CPT Codes Effective January 1, 2025</li><li>­ <u>2025 Status Indicators</u>:  as supplied by CMS, ADDENDUM D1.-- OPPS PAYMENT STATUS INDICATORS FOR CY 2025</li></ul><p><strong>The OPPS APC/HCPCS lookup tool spreadsheet contains the following tabs:</strong></p><ul><li>­ <u>APC Lookup</u>: Allows user to lookup basic information on a given APC. User chooses APC or types in APC in formula bar in cell “B2”. Spreadsheet automatically displays basic descriptive and relevant payment information and the associated HCPCS that belong to that APC. Cells are locked but content can be copied and pasted into another spreadsheet for manipulation.</li><li><u>HCPCS Lookup</u>: Allows user to lookup basic information on a given HCPCS. User chooses HCPCS or types in HCPCS in formula bar in cell “B2”. Spreadsheet automatically displays basic descriptive and relevant payment information and its associated APC.</li><li>­ <u>2025 Status Indicators</u>:  as supplied by CMS, ADDENDUM D1. OPPS PAYMENT STATUS INDICATORS FOR CY 2025</li></ul></div><div class="col-md-4"><h4 class="text-align-center"><span>Download the Spreadsheets below.</span></h4><h4><a href="/system/files/media/file/2025/01/comparison-of-final-2025-opps-addendum-a-with-october-2024-addendum-a.xlsx" target="_blank" title="2025 Addendum A Compared to October 2024">Comparison of Final 2025 OPPS Addendum A with October 2024 Addendum A</a></h4><h4><a href="/system/files/media/file/2025/01/comparison-of-2025-opps-addendum-b-with-october-2024-addendum-b.xlsx" target="_blank" title="2025 Addendum A Compared to October 2024">Comparison of 2025 OPPS Addendum B with October 2024 Addendum B</a></h4><h4><a href="/system/files/media/file/2025/01/2025-opps-apc-hcpcs-final-lookup-tool-spreadsheet.xlsx" target="_blank" title="2025 OPPS APC/HCPCS Final Lookup Tool Spreadsheet">2025 OPPS APC/HCPCS Final Lookup Tool Spreadsheet</a></h4></div></div></div> Mon, 06 Jan 2025 13:45:49 -0600 Dataset /dataset/2024-07-19-2025-nprm-opps-lookup <div class="container"><div class="row"><div class="col-md-8"><p>Lookup Tool: The third spreadsheet is an OPPS APC/HCPCS lookup tool that allows the user to pull-up basic descriptive and payment information for a code.</p></div><div class="col-md-4"><p><a href="/dataset/2024-07-19-2025-nprm-addendum-b-compared-july-2024" target="_blank" title="2025 NPRM Addendum A Compared to July 2024">2025 NPRM Addendum A Compared to July 2024</a></p><p><a href="/dataset/2024-07-19-2025-nprm-addendum-b-compared-july-2024" target="_blank" title="2025 NPRM Addendum B Compared to July 2024">2025 NPRM Addendum B Compared to July 2024</a></p></div></div></div> Fri, 19 Jul 2024 05:27:25 -0500 Dataset /dataset/2024-07-19-2025-nprm-addendum-a-compared-july-2024 <div class="container"><div class="row"><div class="col-md-8"><p>The Addendum A spreadsheet compares relative weights and payment rates at the APC level, using the 2025 proposed rule Addendum A compared to 2024 Addendum A.</p></div><div class="col-md-4"><p><a href="/dataset/2024-07-19-2025-nprm-addendum-b-compared-july-2024" target="_blank" title="2025 Addendum B Compared to July 204">2025 NPRM Addendum B Compared to July 2024</a></p><p><a href="/dataset/2024-07-19-2025-nprm-opps-lookup" target="_blank" title="2025 NPRM OPPS Lookup">2025 NPRM OPPS Lookup</a></p></div></div></div> Fri, 19 Jul 2024 05:07:46 -0500 Dataset /dataset/2024-07-19-2025-nprm-addendum-b-compared-july-2024 <div class="container"><div class="row"><div class="col-md-8"><p>The Addendum B Spreadsheet compares relative weights and payment rates at the HCPCS level, using proposed rule Addendum B compared to 2024 Addendum B.</p></div><div class="col-md-4"><p><a href="/dataset/2024-07-19-2025-nprm-addendum-compared-july-2024" target="_blank" title="2025 NPRM Addendum A Compared to July 2024">2025 NPRM Addendum A Compared to July 2024</a></p><p><a href="/dataset/2023-07-27-2024-nprm-opps-lookup">2024 NPRM OPPS Lookup</a></p></div></div></div> Fri, 19 Jul 2024 05:00:20 -0500 Dataset /dataset/2023-07-27-2024-nprm-opps-lookup <div class="container"> <div class="row"> <div class="col-md-8"> <p>Lookup Tool: The third spreadsheet is an OPPS APC/HCPCS lookup tool that allows the user to pull-up basic descriptive and payment information for a code.</p> </div> <div class="col-md-4"> <p><a href="/dataset/2023-07-27-2024-nprm-addendum-compared-july-2023">2024 NPRM Addendum A Compared to July 2023</a></p> <p><a href="/dataset/2023-07-27-2024-nprm-addendum-b-compared-july-2023">2024 NPRM Addendum B Compared to July 2023</a></p> </div> </div> </div> Thu, 27 Jul 2023 10:49:38 -0500 Dataset /dataset/2023-07-27-2024-nprm-addendum-b-compared-july-2023 <div class="container"> <div class="row"> <div class="col-md-8"> <p>The Addendum B Spreadsheet compares relative weights and payment rates at the HCPCS level, using proposed rule Addendum B compared to 2023 Addendum B (July 1, 2023 file). Spreadsheet cells highlighted in yellow were calculated by Health Policy Alternatives; all other information is from CMS.</p> </div> <div class="col-md-4"> <p><a href="/dataset/2023-07-27-2024-nprm-addendum-compared-july-2023">2024 NPRM Addendum A Compared to July 2023</a></p> <p><a href="/dataset/2023-07-27-2024-nprm-opps-lookup">2024 NPRM OPPS Lookup</a></p> </div> </div> </div> Thu, 27 Jul 2023 10:46:57 -0500 Dataset /dataset/2023-07-27-2024-nprm-addendum-compared-july-2023 <div class="container"> <div class="row"> <div class="col-md-8"> <p>The Addendum A spreadsheet compares relative weights and payment rates at the APC level, using the 2024 proposed rule Addendum A compared to 2023 Addendum A (July 1, 2023 file), as downloaded from the CMS website.</p> </div> <div class="col-md-4"> <p><a href="/dataset/2023-07-27-2024-nprm-addendum-b-compared-july-2023">2024 NPRM Addendum B Compared to July 2023</a></p> <p><a href="/dataset/2023-07-27-2024-nprm-opps-lookup">2024 NPRM OPPS Lookup</a></p> </div> </div> </div> Thu, 27 Jul 2023 10:44:44 -0500 Dataset /dataset/2023-03-16-drugs-adjusted-coinsurance-amounts-quarter-april-1-june-30-2023 <p>A <a href="https://www.cms.gov/files/document/reduced-coinsurance-part-b-rebatable-drugs-apr-1-june-30.pdf" target="_blank" title="CMS.gov: Reduced Coinsurance for Certain Part B Rebatable Drugs under the Medicare Prescription Drug Inflation Rebate Program">March 15 fact sheet issued by CMS</a> includes a list of the first set of Part B rebatable drugs that will be subject to the adjusted coinsurance amounts for the quarter April 1-June 30, 2023.</p> <p>A list of these 27 drugs and biologicals follows:</p> table, th, td { border: 1px solid; } tr:hover {background-color: #b9d9eb33;} <table> <tbody> <tr> <th><strong>HCPCS Code</strong></th> <th><strong>Short Description</strong></th> <th><strong>Inflation-Adjusted Coinsurance Percentage (%)<a href="#fn1">*</a></strong></th> </tr> <tr> <td>J0287</td> <td>Abelcet</td> <td>19.180</td> </tr> <tr> <td>J8655</td> <td>Akynzeo</td> <td>16.213</td> </tr> <tr> <td>J7504</td> <td>Atgam</td> <td>17.830</td> </tr> <tr> <td>J3145</td> <td>Aveed</td> <td>19.239</td> </tr> <tr> <td>J0558</td> <td>Bicillin C-R</td> <td>18.921</td> </tr> <tr> <td>J0561</td> <td>Bicillin L-A</td> <td>18.514</td> </tr> <tr> <td>J1955</td> <td>Carnitor</td> <td>13.918</td> </tr> <tr> <td>J0850</td> <td>Cytogam</td> <td>18.983</td> </tr> <tr> <td>J9269</td> <td>Elzonris</td> <td>19.969</td> </tr> <tr> <td>J0699</td> <td>Fetroja</td> <td>10.274</td> </tr> <tr> <td>J1572</td> <td>Flebogamma DIF</td> <td>17.655</td> </tr> <tr> <td>J9307</td> <td>Folotyn</td> <td>19.965</td> </tr> <tr> <td>J1645</td> <td>Fragmin</td> <td>13.995</td> </tr> <tr> <td>J0135</td> <td>Humira</td> <td>19.529</td> </tr> <tr> <td>J2820</td> <td>Leukine</td> <td>19.648</td> </tr> <tr> <td>J2265</td> <td>Minocin</td> <td>19.288</td> </tr> <tr> <td>J0888</td> <td>Mircera</td> <td>17.614</td> </tr> <tr> <td>J9268</td> <td>Nipent</td> <td>17.269</td> </tr> <tr> <td>J9177</td> <td>Padcev</td> <td>19.470</td> </tr> <tr> <td>J9061</td> <td>Rybrevant</td> <td>19.747</td> </tr> <tr> <td>J2502</td> <td>Signifor LAR</td> <td>18.406</td> </tr> <tr> <td>J2860</td> <td>Sylvant</td> <td>19.777</td> </tr> <tr> <td>Q2053</td> <td>Tecartus</td> <td>19.958</td> </tr> <tr> <td>J2792</td> <td>Winrho SDF</td> <td>19.882</td> </tr> <tr> <td>J0775</td> <td>Xiaflex</td> <td>18.960</td> </tr> <tr> <td>J3299</td> <td>Xipere</td> <td>18.969</td> </tr> <tr> <td>Q2041</td> <td>Yescarta</td> <td>19.937</td> </tr> </tbody> </table> <p id="fn1"><small>* Normally 20%</small></p> Thu, 16 Mar 2023 13:33:04 -0500 Dataset /aha-hospital-lookup Wed, 16 Nov 2022 11:36:36 -0600 Dataset