Medicare's Bending Cost Curve. July 28, 2014. Table A.1. Service Category Definitions

07/28/2014

Service Category Definition
Acute Inpatient Payments to acute care hospitals (including critical access hospitals) for inpatient services. With regards to the Medicare data, a limited number of hospitals (i.e., all-inclusive rate and no charge structure hospitals) combine bill under Part A for both technical and professional payments. However, most hospitals bill Part B separately for services provided by employed physicians.
Ambulatory Surgery Center (ASC) Payments to ASCs.
Anesthesia Payments for anesthesia services delivered in non-institutional settings, aside from ASCs.
Dialysis Predominantly professional payments – for dialysis services. Treatments are generally captured under hospital outpatient.
Durable Medical Equipment (DME) Payments for DME provided in non-institutional settings, aside from ASCs.
Home Health Payments for home health services.
Hospice Payments for hospice services
Hospital Outpatient Department (HOPD) Payments to hospitals for outpatient department services. With regards to the Medicare data, this category also includes payments to independently operated dialysis facilities, since they bill using the CMS UB-40 form.
Imaging Payments for imaging services provided in non-institutional settings, aside from ASCs.
Part B Drugs Payments for drugs provided in non-institutional settings, aside from ASCs.
Other Inpatient Payments to long-term care hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities, and other types of specialty facilities such as children’s hospitals and cancer centers for inpatient services.
Other Procedures Payments for procedures other than anesthesia or dialysis provided in non-institutional settings, aside from ASCs.
Other Professional Other professional payments for services that do not fall under one of the other carrier service categories (i.e., DME, Office-Based Drugs, Physician E&M, ASC, Anesthesia, Dialysis, Tests, Other Procedures, and Imaging). Example services included in the other professional category include ambulance, chiropractor, chemotherapy, vision, hearing, and speech services.
Physician Evaluation and Management (E&M) Payments to physicians for evaluation and management services, aside from when such services are rendered in an ASC.
Part D Payments for prescribed drugs. With regards to the Medicare data, this measures includes the amount paid by the plan and the low income cost sharing subsidy amount, if applicable.
Skilled Nursing Facility (SNF) Payments for SNF services.
Testing Payments for lab and other non-imaging testing services provided in non-institutional settings, aside from ASCs.

 

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