Hospital APG Base Rates Using Full APG Investment

Peer Group ∗∗Base Rate Code ∗∗∗Blend Rate Code Capital Rate Code Region 12/01/2008 01/01/2009 04/01/2009 07/01/2009 10/01/2009 12/01/2009 01/01/2010 07/01/2010 10/01/2010 01/01/2011 04/01/2011 07/01/2011 01/01/2012 05/01/2012
Amb Surg 1401 NA 1404 Downstate $ 162.53 $ 162.53 $ 162.53 $ 156.91 $ 156.91 $ 156.91 $ 228.00 $ 215.50 $ 215.50 $ 197.29 $ 197.29 $ 195.59 $ 195.59 $ 195.59
Amb Surg 1401 NA 1404 Upstate $ 132.04 $ 132.04 $ 132.04 $ 122.55 $ 122.55 $ 122.55 $ 176.13 $ 166.47 $ 166.47 $ 152.41 $ 152.41 $ 151.09 $ 151.09 $ 151.09
Clinic∗ 1400 1406 1403 Downstate $ 276.38 $ 276.38 $ 276.38 $ 258.90 $ 258.90 $ 274.23 $ 304.39 $ 325.95 $ 313.50 $ 240.17 $ 224.47 $ 231.93 $ 199.89 $ 183.53
Clinic∗ 1400 1406 1403 Upstate $ 219.69 $ 219.69 $ 219.69 $ 199.00 $ 199.00 $ 210.79 $ 233.97 $ 249.56 $ 240.98 $ 184.61 $ 172.54 $ 178.28 $ 153.65 $ 140.52
Clinic Episode∗ 1432 1433 1434 Downstate $ 258.90 $ 258.90 $ 274.23 $ 304.39 $ 325.95 $ 313.50 $ 240.17 $ 224.47 $ 231.93 $ 199.89 $ 183.53
Clinic Episode∗ 1432 1433 1434 Upstate $ 199.00 $ 199.00 $ 210.79 $ 233.97 $ 249.56 $ 240.98 $ 184.61 $ 172.54 $ 178.28 $ 153.65 $ 140.52
Clinic MR/DD/TBI∗[1] 1501 1502 1503 Downstate $ 325.95 $ 313.50 $ 240.17 $ 224.47 $ 231.93 $ 199.89 $ 183.53
Clinic MR/DD/TBI∗[1] 1501 1502 1503 Upstate $ 249.56 $ 240.98 $ 184.61 $ 172.54 $ 178.28 $ 153.65 $ 140.52
Clinic MR/DD/TBI Episode∗[1] 1489 1490 1491 Downstate $ 325.95 $ 313.50 $ 240.17 $ 224.47 $ 231.93 $ 199.89 $ 183.53
Clinic MR/DD/TBI Episode∗[1] 1489 1490 1491 Upstate $ 249.56 $ 240.98 $ 184.61 $ 172.54 $ 178.28 $ 153.65 $ 140.52
Emergency Department (ED) 1402 NA 1405 Downstate $ 189.15 $ 189.15 $ 175.11 $ 175.11 $ 175.11 $ 196.94 $ 184.98 $ 184.98 $ 184.98 $ 193.41 $ 197.38 $ 197.38 $ 197.38
Emergency Department (ED) 1402 NA 1405 Upstate $ 152.04 $ 152.04 $ 135.27 $ 135.27 $ 135.27 $ 153.81 $ 144.47 $ 144.47 $ 144.47 $ 151.05 $ 154.15 $ 154.15 $ 154.15
School-Based Health Center (SBHC)∗ 1444 1445 1446 Downstate $ 276.38 $ 258.90 $ 258.90 $ 274.23 $ 304.39 $ 325.95 $ 313.50 $ 240.17 $ 224.47 $ 231.93 $ 199.89 $ 183.53
School-Based Health Center (SBHC)∗ 1444 1445 1446 Upstate $ 219.69 $ 199.00 $ 199.00 $ 210.79 $ 233.97 $ 249.56 $ 240.98 $ 184.61 $ 172.54 $ 178.28 $ 153.65 $ 140.52
SBHC Episode∗ 1450 1451 1452 Downstate $ 258.90 $ 274.23 $ 304.39 $ 325.95 $ 313.50 $ 240.17 $ 224.47 $ 231.93 $ 199.89 $ 183.53
SBHC Episode∗ 1450 1451 1452 Upstate $ 199.00 $ 210.79 $ 233.97 $ 249.56 $ 240.98 $ 184.61 $ 172.54 $ 178.28 $ 153.65 $ 140.52
∗For Clinic (effective 12/1/2008), School-Based Health Center [SBHC] (effective 4/1/2009) & 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.
∗∗Schedule provides Base Rates only. For the Existing Rate for Blend and Capital Add-on rates, refer to the Rate by Provider files.
∗∗∗The Blend (Existing Rate for Blend) rates were set to $0 effective 1/1/2012 as the APG payment now reflects 100% of the Base rate.
[1] MR/DD/TBI Rates: Currently do not receive the 20% increase (still waiting CMS approval). Rates are the same rates as clinic.
Rates not available during this time period.