INPATIENT EXEMPT UNIT RATES EFFECTIVE 7/1/2014 - 12/31/2014 (MA FFS ONLY)

MEDICAID FEE-FOR-SERVICE PUB
(1) (2) (3) (4)
PSYCHIATRIC
PSYCHIATRIC OPERATING BILLING RATE PSYCHIATRIC NON-OPERATING BILLING RATE PSYCHIATRIC ECT PAYMENT PSYCHIATRIC ALC PER DIEM
OPCERT HOSPITAL NAME (2852) (2571) (2570) (2962,2963)
1623001 ADIRONDACK MEDICAL CENTER $716.31 $60.03 $231.32 $171.74
0101000 ALBANY MEDICAL CTR HOSP $614.25 $207.00 $244.16 $171.74
0501000 AUBURN COMMUNITY HOSPITAL $750.25 $41.05 $242.28 $171.74
7002001 BELLEVUE HOSPITAL CENTER $657.63 $177.09 $287.55 $261.20
7002002 BETH ISRAEL MEDICAL CENTER $726.46 $295.46 $317.64 $261.20
3535001 BON SECOURS COMMUNITY HOSP $589.64 $31.23 $257.82 $171.74
7000001 BRONX-LEBANON HOSPITAL CTR $684.30 $255.48 $299.21 $261.20
7001002 BROOKDALE HOSPITAL MED CTR $673.25 $120.22 $294.38 $261.20
5123000 BROOKHAVEN MEMORIAL HOSP $654.42 $39.38 $286.14 $261.20
5263000 CATSKILL REGIONAL MED CTR $796.11 $31.12 $257.09 $171.74
5401001 CAYUGA MEDICAL CENTER $766.78 $43.59 $247.62 $171.74
0901001 CHAMPLAIN VALLEY PHYS $731.19 $58.01 $236.12 $171.74
4401000 CLAXTON-HEPBURN MED CTR $669.32 $36.57 $216.15 $171.74
3421000 CLIFTON SPRINGS HOSPITAL $604.58 $26.25 $195.24 $171.74
1001000 COLUMBIA MEMORIAL HOSPITAL $713.96 $30.03 $230.56 $171.74
7001009 CONEY ISLAND HOSPITAL $649.73 $175.83 $284.09 $261.20
1101000 CORTLAND REGIONAL MED CTR $698.73 $78.20 $225.64 $171.74
5127000 EASTERN LONG ISLAND HOSPITAL $636.49 $63.69 $278.30 $261.20
3101000 EASTERN NIAGARA HOSPITAL $571.41 $15.04 $227.13 $171.74
4601001 ELLIS HOSPITAL $593.89 $34.53 $236.07 $171.74
7003000 ELMHURST HOSPITAL CTR $691.69 $322.61 $302.44 $261.20
1401005 ERIE COUNTY MEDICAL CENTER $651.64 $60.07 $259.03 $171.74
3202003 FAXTON-ST LUKES HEALTHCARE $722.92 $63.14 $233.45 $171.74
7003001 FLUSHING HOSPITAL $664.00 $152.77 $290.33 $261.20
2910000 FRANKLIN HOSPITAL $631.67 $37.89 $276.19 $261.20
2901000 GLEN COVE HOSPITAL $725.43 $40.72 $317.19 $261.20
5601000 GLENS FALLS HOSPITAL $709.00 $54.46 $228.96 $171.74
7002009 HARLEM HOSPITAL CENTER $675.37 $268.54 $295.30 $261.20
5501000 HEALTHALLIANCE HOSP MARYS AVE CAMPUS $759.30 $22.48 $245.20 $171.74
5153000 HUNTINGTON HOSPITAL $679.93 $42.18 $297.30 $261.20
7001046 INTERFAITH MEDICAL CENTER $677.24 $37.99 $296.12 $261.20
7000002 JACOBI MEDICAL CENTER $712.90 $249.57 $311.71 $261.20
7003003 JAMAICA HOSPITAL $722.41 $235.62 $315.87 $261.20
5149000 JOHN T MATHER MEMORIAL HOSP $661.04 $68.87 $289.04 $261.20
7001016 KINGS COUNTY HOSPITAL CENTER $651.98 $326.58 $285.07 $261.20
7001033 KINGSBROOK JEWISH MED CTR $737.90 $50.82 $322.64 $261.20
7002017 LENOX HILL HOSPITAL $668.82 $190.30 $292.44 $261.20
7000008 LINCOLN MEDICAL $663.29 $293.16 $290.02 $261.20
7003004 LONG ISLAND JEWISH $699.34 $143.79 $305.78 $261.20
7001019 LUTHERAN MEDICAL CENTER $653.71 $100.59 $285.83 $261.20
7001020 MAIMONIDES MEDICAL CENTER $765.02 $103.03 $334.50 $261.20
3824000 MARY IMOGENE BASSETT HOSP $655.92 $36.89 $211.82 $171.74
2909000 MERCY MEDICAL CENTER $653.39 $45.80 $285.69 $261.20
7002021 METROPOLITAN HOSPITAL CENTER $656.22 $291.47 $286.93 $261.20
7000006 MONTEFIORE MEDICAL CENTER $721.64 $593.74 $315.53 $261.20
5903001 MONTEFIORE MOUNT VERNON HOSP $678.01 $18.38 $296.46 $261.20
7002024 MOUNT SINAI HOSPITAL $720.16 $157.76 $314.89 $261.20
2950002 NASSAU UNIV MED CTR $727.75 $55.56 $318.20 $261.20
3102000 NIAGARA FALLS MEMORIAL $549.14 $27.95 $218.28 $171.74
7000024 NORTH CENTRAL BRONX HOSPITAL $733.15 $143.51 $320.56 $261.20
2951001 NORTH SHORE UNIVERSITY HOSP $746.58 $519.80 $326.44 $261.20
5920000 NORTHERN WESTCHESTER HOSP $650.11 $110.92 $284.26 $261.20
4324000 NYACK HOSPITAL $626.59 $21.36 $273.98 $261.20
7001021 NY METHODIST HOSP / BROOKLYN $686.55 $148.33 $300.19 $261.20
7002054 NY PRESBYTERIAN HOSPITAL $718.75 $156.55 $314.27 $261.20
7002053 NYU HOSPITALS CENTER $687.71 $626.57 $300.70 $261.20
0401001 OLEAN GENERAL HOSPITAL $668.37 $54.48 $215.84 $171.74
3523000 ORANGE REGIONAL MED CTR $639.96 $127.94 $279.82 $171.74
3702000 OSWEGO HOSPITAL $716.05 $56.12 $231.23 $171.74
5932000 PHELPS MEMORIAL HOSP $642.66 $72.40 $281.00 $261.20
3950000 PUTNAM COMMUNITY HOSPITAL $659.18 $32.44 $288.22 $171.74
7003007 QUEENS HOSPITAL CENTER $732.50 $291.39 $320.28 $261.20
7004010 RICHMOND UNIV MED CTR $642.53 $40.39 $280.94 $261.20
2701003 ROCHESTER GENERAL HOSPITAL $600.25 $70.70 $238.60 $171.74
3201002 ROME MEMORIAL HOSPITAL $670.63 $23.95 $216.57 $171.74
4102002 SAMARITAN HOSPITAL OF TROY $562.08 $22.28 $223.42 $171.74
2201000 SAMARITAN MEDICAL CENTER $734.76 $43.93 $237.28 $171.74
4501000 SARATOGA HOSPITAL $588.30 $38.64 $233.85 $171.74
6120700 SOLDIERS AND SAILORS MEM HOSP $583.35 $61.39 $188.38 $171.74
2950001 SOUTH NASSAU COMMUNITIES $619.01 $86.43 $270.66 $261.20
5154000 SOUTHSIDE HOSPITAL $672.74 $61.01 $294.15 $261.20
7000014 ST BARNABAS HOSPITAL $659.82 $109.21 $288.50 $261.20
5157003 ST CATHERINE OF SIENA $679.87 $60.29 $297.27 $261.20
3202002 ST ELIZABETH MEDICAL CENTER $730.15 $27.12 $235.79 $171.74
1302000 ST FRANCIS HOSP / POUGH $555.26 $70.16 $242.78 $171.74
7001024 ST JOHNS EPISCOPAL SO SHORE $767.14 $123.89 $335.43 $261.20
0701001 ST JOSEPHS HOSP / ELMIRA $646.44 $14.69 $208.75 $171.74
3301003 ST JOSEPHS HOSP HLTH CTR $624.64 $52.70 $248.29 $171.74
5907002 ST JOSEPHS MEDICAL CENTER $658.41 $44.96 $287.88 $261.20
7002032 ST LUKES / ROOSEVELT HOSP $782.82 $133.07 $342.29 $261.20
2801001 ST MARYS HOSP / AMSTERDAM $657.49 $22.66 $212.32 $171.74
7001037 STATE UNIV HOSP / DOWNSTATE $701.08 $218.90 $306.54 $261.20
7004003 STATEN ISLAND UNIV HOSP $654.10 $107.64 $286.00 $261.20
2701005 STRONG MEMORIAL HOSPITAL $635.95 $105.43 $252.79 $171.74
2754001 THE UNITY HOSP OF ROCHESTER $548.01 $49.81 $217.83 $171.74
0427000 TLC HEALTH NETWORK $593.79 $35.63 $191.75 $171.74
0303001 UNITED HEALTH SERVICES INC $599.76 $38.70 $238.40 $171.74
5151001 UNIV HOSP AT STONY BROOK $659.18 $187.49 $288.22 $261.20
3301007 UNIV HOSP SUNY HLTH SCI CTR $649.24 $155.76 $258.07 $171.74
3301003 UPSTATE UNIV HOSP/COMM GEN $654.90 $33.99 $260.32 $171.74
5820000 WAYNE HEALTH CARE $672.98 $48.62 $217.33 $171.74
5957001 WESTCHESTER MEDICAL CENTER $732.18 $163.34 $320.14 $261.20
0602001 WOMANS CHRISTIAN ASSOC $645.31 $32.27 $208.39 $171.74
7001045 WOODHULL MEDICAL $653.91 $110.05 $285.92 $261.20
6027000 WYOMING CO COMMUNITY HOSP $675.15 $52.43 $218.03 $171.74