2018 reimbursement guide - tela bio...6 cpt code description physician fee scheduleii (mpfs) apc...

2018 REIMBURSEMENT GUIDE for Hernia Repair Procedures Using OviTex® Reinforced BioScaffolds

Laparoscopic Repair – Hernia......................06

ICD-10-PCS Codes.........14

Hiatal Hernia Repair........08

Medicare Hospital Inpatient Payment (MS-DRG)..........................16

Stoma Procedures...........11

Component Separation Technique and Hernia Repair.........................03

HCPCS Level II Codes..........13

TABLE OF CONTENTS:

Modifiers.................................13

SCIENCE. VALUE. INNOVATION.

ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES

MODIFIERCODES $ICD-10

CODESHCPCSCODES

MODIFIERCODES $ ICD-10

CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

2


OviTex Reinforced BioScaffolds are implants purposefully designed for hernia and abdominal wall reconstruction that combine biologic and synthetic materials

in a unique embroidered construction. OviTex products are intended for use as a surgical mesh to reinforce and/

or repair soft tissue where weakness exists. Indications for use include the repair of hernias and/or abdominal

wall defects that require the use of reinforcing or bridging material to obtain the desired surgical outcome. OviTex

products are available in various shapes, sizes, and configurations to suit surgeon preference and the complexity

of the soft tissue repair. The device may be trimmed to a desired shape to further accommodate an individual

patient’s requirements. OviTex is compatible with all surgical techniques: open, laparoscopic, and robotic

approaches.

PHYSICIAN, HOSPITAL OUTPATIENT, AND ASC CODING AND MEDICARE REIMBURSEMENT

The following table provides 2018 national average Medicare Physician Fee Schedule (MPFS), Hospital

Outpatient Ambulatory Payment Category (APC), and Ambulatory Surgery Center (ASC) payment rates for the

CPT codes relating to hernia and abdominal repair procedures identified in this guide. Payments will vary by

geographic locality.


3

CPT Code DescriptionPhysician

Fee Scheduleii

(MPFS)

APCAssignment

HospitalOutpatientPaymentiii

Ambulatory Surgery Center

Paymentiv

Component Separation Technique

15734 Muscle, myocutaneous, or fasciocutaneous flap; trunk (Note: Report 15734 twice if procedure is bilateral)

$1,568.14 5055 $2,710.30 $1,412.16

Hernia Repair

11008 Removal of mesh in abdominal wall for infection $286.56 -- Inpatient Only

Excluded From Payment in ASCs for CY 2018

49500 Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible

$428.76 5341 $2,910.96 $1,332.80

49501 Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; incarcerated or strangulated

$630.35 5341 $2,910.96 $1,332.80

49505 Repair initial inguinal hernia, age 5 years or older; reducible

$541.07 5341 $2,910.96 $1,332.80

CPTi Codes and 2018 National Average Medicare Reimbursement for Common Hernia Repair and Abdominal Wall Procedures


ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $ICD-10CODES

HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $


4


Fee Scheduleii

(MPFS)

APCAssignment



Paymentiv

Hernia Repair (Continued)

49507 Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated

$609.83 5341 $2,910.96 $1,332.80

49520 Repair recurrent inguinal hernia, any age; reducible $657.35 5341 $2,910.96 $1,332.80

49521 Repair recurrent inguinal hernia, any age; incarcerated or strangulated

$745.55 5341 $2,910.96 $1,332.80

49525 Repair inguinal hernia, sliding, any age $595.43 5341 $2,910.96 $1,332.80

49540 Repair lumbar hernia $699.11 5361 $4,488.37 $2,097.42

49560 Repair initial incisional or ventral hernia; reducible $767.87 5341 $2,910.96 $1,332.80

49561 Repair initial incisional or ventral hernia; incarcerated or strangulated

$968.03 5341 $2,910.96 $1,332.80

49565 Repair recurrent incisional or ventral hernia; reducible

$799.19 5361 $4,488.37 $2,097.42

49566 Repair recurrent incisional or ventral hernia; incarcerated or strangulated

$976.67 5361 $4,488.37 $2,097.42



ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $


5


Fee Scheduleii

(MPFS)

APCAssignment



Paymentiv

Hernia Repair (Continued)

+49568 Implantation of mesh or other prosthesis for incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair)

$279.36 5341 $2,910.96Packaged Service/Item; No Separate Payment

Made

49570 Repair epigastric hernia (eg, preperitoneal fat); reducible (separate procedure)

$434.52 5341 $2,910.96 $1,332.80

49572 Repair epigastric hernia (eg, preperitoneal fat); incarcerated or strangulated

$536.03 5341 $2,910.96 $1,332.80

49580 Repair umbilical hernia, younger than age 5 years; reducible

$345.96 5341 $2,910.96 $1,332.80

49582 Repair umbilical hernia, younger than age 5 years; incarcerated or strangulated

$502.19 5341 $2,910.96 $1,332.80

49585 Repair umbilical hernia, age 5 years or older; reducible $462.95 5341 $2,910.96 $1,332.80

49587 Repair umbilical hernia, age 5 years or older; incarcerated or strangulated

$494.63 5341 $2,910.96 $1,332.80

49590 Repair spigelian hernia $595.43 5341 $2,910.96 $1,332.80


ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $



6


Fee Scheduleii

(MPFS)

APCAssignment



Paymentiv

Laparoscopic Repair - Hernia

49650 Laparoscopy, surgical; repair initial inguinal hernia $446.04 5361 $4,488.37 $2,097.42

49651 Laparoscopy, surgical; repair recurrent inguinal hernia $578.15 5361 $4,488.37 $2,097.42

49652 Laparoscopy, surgical, repair, ventral, umbilical, spigelian, or epigastric hernia (includes mesh insertion, when performed); reducible

$774.35 5361 $4,488.37 $2,097.42

49653 Laparoscopy, surgical, repair, ventral, umbilical, spigelian, or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated

$965.51 5361 $4,488.37 $2,097.42

49654 Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible

$880.55 5362 $7,594.89 $3,368.82


ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $



7


Fee Scheduleii

(MPFS)

APCAssignment



Paymentiv

Laparoscopic Repair - Hernia

49655 Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated

$1,074.59 5362 $7,594.89 $3,368.82

49656 Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible

$955.43 5362 $7,594.89 $3,368.82

49657 Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated

$1,374.46 5362 $7,594.89 $3,368.82

49659* Unlisted lap procedure, hernioplasty, herniorrhaphy, herniotomy parastomal hernia repair

Contractor Priced 5361 $4,488.37Excluded From Payment

in ASCs for CY 2018

44346 Revision of colostomy; with repair of paracolostomy hernia (separate procedure)

$1234.79 -- Inpatient OnlyExcluded From Payment

in ASCs for CY 2018


ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $



(Continued)

* CPT 49659 Physician status code is “C”. C = Contractor priced. Medicare Administrative Contractors will establish payment amounts for these services, generally on an individual case basis, following review of documentation, such as an operative report.

8


Fee Scheduleii

(MPFS)

APCAssignment



Paymentiv

Hiatal Hernia Repair

39540 Repair, diaphragmatic hernia (other than neonatal), traumatic; acute


in ASCs for CY 2018

39541 Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic


in ASCs for CY 2018

43280 Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures)

$1,127.15 5362 $7,594.89Excluded From Payment

in ASCs for CY 2018

43281 Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh

$1,609.90 5362 $7,594.89Excluded From Payment

in ASCs for CY 2018

43282 Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh

$1,810.42 5362 $7,594.89 Excluded From Payment in ASCs for CY 2018


ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $



9


Fee Scheduleii

(MPFS)

APCAssignment



Paymentiv

Hiatal Hernia Repair (Continued)

43283 Laparoscopy, surgical, esophageal lengthening procedure (eg, Collis gastroplasty or wedge gastroplasty) (List separately in addition to code for primary procedure)


in ASCs for CY 2018

43332 Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; without implantation of mesh or other prosthesis

$1,209.59 -- Inpatient OnlyExcluded From Payment

in ASCs for CY 2018

43333 Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis


in ASCs for CY 2018

43334 Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; without implantation of mesh or other prosthesis


in ASCs for CY 2018


ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $



10


Fee Scheduleii

(MPFS)

APCAssignment



Paymentiv

Hiatal Hernia Repair (Continued)

43335 Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; with implantation of mesh or other prosthesis


in ASCs for CY 2018

43336 Repair, paraesophageal hiatal hernia (including fundoplication), via thoracoabdominal incision, except neonatal; without implantation of mesh or other prosthesis


in ASCs for CY 2018

43337 Repair, paraesophageal hiatal hernia (including fundoplication), via thoracoabdominal incision, except neonatal; with implantation of mesh or other prosthesis


in ASCs for CY 2018

0437T Implantation of non-biologic or synthetic implant (eg, polypropylene) for fascial reinforcement of the abdominal wall (List separately in addition to code for primary procedure)**

Contractor Priced --Packaged Service/Item; No Separate Payment

Made

Packaged Service/Item; No Separate Payment

Made


ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $



** As with most add-on codes, this code is approved to be used with only certain primary procedures. Please refer to your CPT manual for approved primary procedures.

11


Fee Scheduleii

(MPFS)

APCAssignment



Paymentiv

Stoma Procedures

44141 Colectomy, partial; with skin level cecostomy or colostomy


in ASCs for CY 2018

44143 Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure)


in ASCs for CY 2018

44144 Colectomy, partial; with resection, with colostomy or ileostomy and creation of mucofistula


in ASCs for CY 2018

44312 Revision of ileostomy; simple (release of superficial scar) (Separate procedure)

$616.67 5055 $2,710.30 $1,412.16

44206 Laparoscopy, surgical; colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure)


in ASCs for CY 2018


ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $



12


Fee Scheduleii

(MPFS)

APCAssignment



Paymentiv

Stoma Procedures (Continued)

44314 Revision of ileostomy; complicated (reconstruction in-depth) (Separate procedure)


in ASCs for CY 2018

44320 Colostomy or skin level cecostomy $1,253.15 -- Inpatient Only

Excluded From Payment in ASCs for CY 2018

44340 Revision of colostomy; simple (release of superficial scar) (Separate procedure)

$649.79 5055 $2,710.30 $1,412.16

44345 Revision of colostomy; complicated [reconstruction in-depth] (Separate procedure)


in ASCs for CY 2018

44346 Revision of colostomy; with repair of paracolostomy hernia (Separate procedure)


in ASCs for CY 2018

44605 Suture of large intestine; (colorrhaphy) for perforated ulcer, diverticulum, wound, injury, or rupture (single or multiple perforations); with colostomy


in ASCs for CY 2018


ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $



13

Codes Description

C1781Mesh (Implantable) – (ie, Davol Synthetic Mesh, AlloMax™ Surgical Graft, Phasix™ Mesh, Phasix™ ST Mesh, XenMatrix™ Surgical Graft and XenMatrix™ AB Surgical Graft)

Modifier Description

50 Bilateral Procedure

51 Multiple Procedures

59 Distinct Procedural Service


HCPCS Level II Codesv The following is the HCPCS Level II code that relates to hernia repair procedures using OviTex:

Modifiers Modifiers explain that a procedure or service was changed without changing the definition of the CPT code set. Here are some common modifiers related to hernia repair procedures.

ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $


14

ICD-10-PCS Codes Series Descriptors

0BQ Repair/Respiratory System

0BU Supplement/Respiratory System

0D8 Division/Gastrointestinal System

0DB Excision/Gastrointestinal System

0DJ Inspection/Gastrointestinal System

0DN Release/Gastrointestinal System

0DQ Repair/Gastrointestinal System

0DT Resection/Gastrointestinal System

0DU Supplement/Gastrointestinal System

0DV Restriction/Gastrointestinal System

0F5 Destruction/Hepatobiliary System and Pancreas


ICD-10-PCS Codesvi ICD-10-CM (diagnosis) and ICD-10-PCS (procedure) codes were implemented October 1, 2015. It is the physician’s responsibility to select the codes that appropriately represent the service performed, as well as to report the ICD-10-CM code based on the findings or the pre-service signs, symptoms, or conditions of the individual patient.

The following are examples of series descriptors of ICD-10-PCS procedure codes that relate to hernia repair procedures (not an all inclusive list).

ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $


15

ICD-10-PCS Codes Series Descriptors

0FB Excision/Hepatobiliary System and Pancreas

0FJ Inspection/Hepatobiliary System and Pancreas

0FN Release/Hepatobiliary System and Pancreas

0FT Resection/Hepatobiliary System and Pancreas

0W2 Change/Anatomical Regions, General

0WJ Inspection/Anatomical Regions, General

0WQ Repair/Anatomical Regions, General

0WU Supplement/Anatomical Regions, General

0YQ Repair/Anatomical Regions, Lower Extremities

0YU Supplement/Anatomical Regions, Lower Extremities


ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $


16

MS-DRG Description National Average MS-DRG Ratevii

Hernia Repair

350 Inguinal and Femoral Hernia Procedures With MCC* $14,832.09

351 Inguinal and Femoral Hernia Procedures With CC** $8,977.62

352 Inguinal and Femoral Hernia Procedures Without CC/MCC $6,254.13

353 Hernia Procedures Except Inguinal and Femoral With MCC $18,143.32

354 Hernia Procedures Except Inguinal and Femoral With CC $10,390.60

355 Hernia Procedures Except Inguinal and Femoral Without CC/MCC $7,960.68


Medicare Hospital Inpatient Payment (MS-DRG) Payment for inpatient hospital services is based on a classification system determined by patient diagnosis known as Medicare Severity - Diagnosis Related Groups (MS-DRGs). The MS-DRG assignment is based on the combination of ICD-10-CM and ICD-10-PCS codes reported. Only one MS-DRG is assigned to a patient for a particular hospital admission. Therefore, one payment is made per patient and that payment is based upon the MS-DRG assignment.

The following are examples of series descriptors of ICD-10-PCS procedure codes that relate to hernia repair procedures (not an all inclusive list).

MS-DRGs and 2018 National Average Medicare Rates for Hernia and Abdominal Wall Repair Procedures

ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $


17


Parastomal

347 Anal and Stomal Procedures With MCC $15,847.22

348 Anal and Stomal Procedures With CC $8,510.44

349 Anal and Stomal Procedures Without CC/MCC $6,116.69

Hiatal

326 Stomach, Esophageal, and Duodenal Procedures With MCC $27,410.89

327 Stomach, Esophageal, and Duodenal Procedures With CC $12,754.81

328 Stomach, Esophageal, and Duodenal Procedures Without CC/MCC $9,067.44

Abdominal Wall

335 Peritoneal Adhesiolysis With MCC $24,678

336 Peritoneal Adhesiolysis With CC $14,103

337 Peritoneal Adhesiolysis Without CC/MCC $9,755


ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $


18


Small Bowel and Large Bowel/Intestinal Procedures

329 Major Small & Large Bowel Procedures With MCC $29,615

330 Major Small & Large Bowel Procedures With CC $14,880

331 Major Small & Large Bowel Procedures Without CC/MCC $10,101

332 Rectal Resection With MCC $23,036

333 Rectal Resection With CC $12,011

334 Rectal Resection Without CC/MCC $7,817

347 Anal & Stomal Procedures With MCC $15,847

348 Anal & Stomal Procedures With CC $8,510

349 Anal & Stomal Procedures Without CC/MCC $6,117


Major complications and/or comorbidityComplications and/or comorbidity

ICD-10CODES

HCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $

ICD-10CODES

HCPCSCODES


CODESHCPCSCODES


HCPCSCODES


CODESHCPCSCODES

MODIFIERCODES $


19


Information presented in this document is current as of December 6, 2017. Any subsequent changes which may occur in coding, coverage and payment are not reflected herein. TELA Bio does not guarantee that use of the codes noted above will ensure coverage and/or payment. It is always the provider’s responsibility to determine and submit appropriate codes, charges, modifiers and bills for the services that were rendered. This information is provided as of the date listed above, and all coding and reimbursement information is subject to change without notice. Payers or their local branches may have their own coding and reimbursement requirements and policies. Before filing any claims, providers should verify current requirements and policies with the payer.

Do not use OviTex in patients known to be sensitive to materials of ovine (sheep) origin. For additional important safety information, please see the OviTex Reinforced BioScaffold Instructions for Use.

For Prescription Use Only. TELA Bio, Inc. owns or has applied for the following trademarks or service marks: TELA Bio, OviTex. All other trademarks are trademarks of their respective owners or holders.

MK-EM-0031 rev00 (January 2018)

Disclaimer

Referencesi CPT codes and descriptions only are copyright © 2016 American Medical Association. All rights reserved. No fee schedules are included in CPT.

The American Medical Association assumes no liability for data contained or not contained herein. ii Federal Register / Vol. 82, No. 219 / Wednesday, November 15, 2017

https://www.gpo.gov/fdsys/pkg/FR-2017-11-15/pdf/2017-23953.pdf.iii

Federal Register / Vol. 82, No. 217 / Monday, November 13, 2017

https://www.gpo.gov/fdsys/pkg/FR-2017-11-13/pdf/2017-23932.pdf.iv ibid.v PMIC Digital Book Series HCPCS 2018. Copyright 2017 by Practice Management Information Corporation, Los Angeles, CA 90010. All rights

reserved.vi ICD-10-PCS 2018, Practice Management Information Corporation (PMIC). Copyright © 2017 Uniform Copyright Convention.vii Federal Register / Vol. 82, No. 155 / Monday, August 14, 2017. Note: The payment amounts indicated are estimates only based upon information

published in CMS-1677-F, released 8/2/17 and related data tables. Calculations assume that all hospitals are receiving the full quality reporting

and meaningful EHR update of 1.35%. Actual payment may vary based on hospital-specific factors not reflected in the source data. Actual payment

may also vary based on adjustments that CMS may make from time to time. Payment amounts include uncompensated care payment (UCP). They

do not include the 1% hospital acquired condition (HAC) adjustment, nor the 2% sequestration adjustment.


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