Hospital Base Rates and Rate Codes

Service Type Blend Rate Visit / Episode Rate Code Capital Add-On Visit / Episode Rate Code ∗∗Base Rate Visit / Episode Rate Code APG Base Rates
(Effective
December 1, 2008 thru December 31, 2008)
APG Base Rates
(Effective
January 1, 2009
thru June 30, 2009)
APG Base Rates
(Effective
July 1, 2009
thru November 30, 2009)
APG Base Rates
(Effective
December 1, 2009
thru December 31, 2009)
APG Base Rates
(Effective
January 1, 2010
thru June 30, 2010)
APG Base Rates
(Effective
July 1, 2010
thru December 31, 2010)
APG Base Rates
(Effective
January 1, 2011
Forward)
Downstate Upstate Downstate Upstate Downstate Upstate Downstate Upstate Downstate Upstate Downstate Upstate Downstate Upstate
Ambulatory Surgery N/A 1404 1401 $162.53 $132.04 $162.53 $132.04 $156.91 $122.55 $156.91 $122.55 $228.00 $176.13 $215.50 $166.47 $197.29 $152.41
Emergency Department N/A 1405 1402 N/A N/A $189.15 $152.04 $175.11 $135.27 $175.11 $135.27 $196.94 $153.81 $184.98 $144.47 ∗∗∗∗ ∗∗∗∗
General Clinic∗∗∗ 1406 / 1433∗ 1403 / 1434∗ 1400 / 1432∗ $276.38 $219.69 $276.38 $219.69 $258.90 $199.00 $199.18 $153.11 $206.48 $158.71 $204.33 $157.07 ∗∗∗∗ ∗∗∗∗
General Clinic MR/DD/TBI∗∗∗ 1502 / 1490∗ 1503 / 1491∗ 1501 / 1489∗ N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $204.33 $157.07 ∗∗∗∗ ∗∗∗∗
School-Based Health Center∗∗∗ 1445 / 1451∗ 1446 / 1452∗ 1444 / 1450∗ N/A N/A 276.38 [1] 219.69 [1] $258.90 $199.00 $199.18 $153.11 $206.48 $158.71 $204.33 $157.07 ∗∗∗∗ ∗∗∗∗

∗∗Schedule provides Base Rates only. For the Blend and Capital Add-On rates, refer to the Rate by Provider files.

∗Episode rate codes effective as follows: General Clinic July 1, 2009, School-Based Health Center October 1, 2009 & MR/DD/TBI July 1, 2010

∗∗∗For General Clinic (effective 12/1/2008), School-Based Health Center (effective 4/1/2009 [1]) & MR/DD/TBI (effective 7/1/2010), while they share the same base payment rates, please note that their rate codes and effective dates differ.

∗∗∗∗Rates are not published. Waiting approval of additional investment by CMS.

Note: At the time CMS approves the additional investments that have been requested by NYS for the Hospital APG rates, the base rates from December 1, 2009 forward will be revised to reflect the increased investment levels.