INPATIENT EXEMPT UNIT RATES EFFECTIVE 1/1/2015 - 12/31/2015 (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 $41.79 $231.32 $187.52
0101000 ALBANY MEDICAL CTR HOSP $614.25 $103.40 $244.16 $187.52
0501000 AUBURN COMMUNITY HOSPITAL $750.25 $29.34 $242.28 $187.52
7002001 BELLEVUE HOSPITAL CENTER $657.63 $167.23 $287.55 $254.96
3535001 BON SECOURS COMMUNITY HOSP $589.64 $34.22 $257.82 $187.52
7000001 BRONX-LEBANON HOSPITAL CTR $684.30 $252.93 $299.21 $254.96
7001002 BROOKDALE HOSPITAL MED CTR $673.25 $127.86 $294.38 $254.96
5123000 BROOKHAVEN MEMORIAL HOSP $654.42 $35.14 $286.14 $254.96
5263000 CATSKILL REGIONAL MED CTR $796.11 $22.41 $257.09 $187.52
5401001 CAYUGA MEDICAL CENTER $766.78 $39.82 $247.62 $187.52
0901001 CHAMPLAIN VALLEY PHYS $731.19 $63.36 $236.12 $187.52
4401000 CLAXTON-HEPBURN MED CTR $669.32 $45.34 $216.15 $187.52
3421000 CLIFTON SPRINGS HOSPITAL $604.58 $18.93 $195.24 $187.52
1001000 COLUMBIA MEMORIAL HOSPITAL $713.96 $23.17 $230.56 $187.52
7001009 CONEY ISLAND HOSPITAL $649.73 $171.32 $284.09 $254.96
1101000 CORTLAND REGIONAL MED CTR $698.73 $107.55 $225.64 $187.52
5127000 EASTERN LONG ISLAND HOSPITAL $636.49 $37.47 $278.30 $254.96
3101000 EASTERN NIAGARA HOSPITAL $571.41 $8.46 $227.13 $187.52
4601001 ELLIS HOSPITAL $593.89 $46.89 $236.07 $187.52
7003000 ELMHURST HOSPITAL CTR $691.69 $307.74 $302.44 $254.96
1401005 ERIE COUNTY MEDICAL CENTER $651.64 $73.20 $259.03 $187.52
3202003 FAXTON-ST LUKES HEALTHCARE $722.92 $60.69 $233.45 $187.52
7003001 FLUSHING HOSPITAL $664.00 $163.01 $290.33 $254.96
2910000 FRANKLIN HOSPITAL $631.67 $41.57 $276.19 $254.96
2901000 GLEN COVE HOSPITAL $725.43 $47.43 $317.19 $254.96
5601000 GLENS FALLS HOSPITAL $709.00 $67.73 $228.96 $187.52
7002009 HARLEM HOSPITAL CENTER $675.37 $328.69 $295.30 $254.96
5501000 HEALTHALLIANCE HOSP MARYS AVE CAMPUS $759.30 $30.72 $245.20 $187.52
5153000 HUNTINGTON HOSPITAL $679.93 $62.50 $297.30 $254.96
7001046 INTERFAITH MEDICAL CENTER $677.24 $68.38 $296.12 $254.96
7000002 JACOBI MEDICAL CENTER $712.90 $254.89 $311.71 $254.96
7003003 JAMAICA HOSPITAL $722.41 $237.28 $315.87 $254.96
5149000 JOHN T MATHER MEMORIAL HOSP $661.04 $66.97 $289.04 $254.96
7001016 KINGS COUNTY HOSPITAL CENTER $651.98 $329.42 $285.07 $254.96
7001033 KINGSBROOK JEWISH MED CTR $737.90 $48.91 $322.64 $254.96
7002017 LENOX HILL HOSPITAL $668.82 $248.98 $292.44 $254.96
7000008 LINCOLN MEDICAL $663.29 $288.11 $290.02 $254.96
7003004 LONG ISLAND JEWISH $699.34 $135.86 $305.78 $254.96
7001019 LUTHERAN MEDICAL CENTER $653.71 $102.12 $285.83 $254.96
7001020 MAIMONIDES MEDICAL CENTER $765.02 $100.46 $334.50 $254.96
3824000 MARY IMOGENE BASSETT HOSP $655.92 $52.24 $211.82 $187.52
2909000 MERCY MEDICAL CENTER $653.39 $37.80 $285.69 $254.96
7002021 METROPOLITAN HOSPITAL CENTER $656.22 $292.80 $286.93 $254.96
1302000 MID-HUDSON VALLEY DIV OF WMC $555.26 $78.06 $242.78 $187.52
7000006 MONTEFIORE MEDICAL CENTER $721.64 $596.08 $315.53 $254.96
5903001 MONTEFIORE MOUNT VERNON HOSP $678.01 $28.69 $296.46 $254.96
7002002 MOUNT SINAI BETH ISRAEL $726.46 $305.38 $317.64 $254.96
7002024 MOUNT SINAI HOSPITAL $720.16 $224.94 $314.89 $254.96
7002032 MOUNT SINAI ST LUKES / ROOSEVELT $782.82 $121.57 $342.29 $254.96
2950002 NASSAU UNIV MED CTR $727.75 $55.38 $318.20 $254.96
5820000 NEWARK-WAYNE COMMUNITY HOSP $672.98 $22.02 $217.33 $187.52
3102000 NIAGARA FALLS MEMORIAL $549.14 $38.07 $218.28 $187.52
7000024 NORTH CENTRAL BRONX HOSPITAL $733.15 $139.71 $320.56 $254.96
2951001 NORTH SHORE UNIVERSITY HOSP $746.58 $520.47 $326.44 $254.96
5920000 NORTHERN WESTCHESTER HOSP $650.11 $83.26 $284.26 $254.96
7001021 NY METHODIST HOSP / BROOKLYN $686.55 $151.44 $300.19 $254.96
7002054 NY PRESBYTERIAN HOSPITAL $718.75 $148.54 $314.27 $254.96
4324000 NYACK HOSPITAL $626.59 $15.91 $273.98 $254.96
7002053 NYU HOSPITALS CENTER $687.71 $578.23 $300.70 $254.96
0401001 OLEAN GENERAL HOSPITAL $668.37 $45.36 $215.84 $187.52
3523000 ORANGE REGIONAL MED CTR $639.96 $150.22 $279.82 $187.52
3702000 OSWEGO HOSPITAL $716.05 $52.05 $231.23 $187.52
5932000 PHELPS MEMORIAL HOSP $642.66 $77.99 $281.00 $254.96
3950000 PUTNAM COMMUNITY HOSPITAL $659.18 $61.61 $288.22 $187.52
7003007 QUEENS HOSPITAL CENTER $732.50 $281.54 $320.28 $254.96
7004010 RICHMOND UNIV MED CTR $642.53 $28.63 $280.94 $254.96
2701003 ROCHESTER GENERAL HOSPITAL $600.25 $60.87 $238.60 $187.52
3201002 ROME MEMORIAL HOSPITAL $670.63 $14.88 $216.57 $187.52
4102002 SAMARITAN HOSPITAL OF TROY $562.08 $21.21 $223.42 $187.52
2201000 SAMARITAN MEDICAL CENTER $734.76 $42.86 $237.28 $187.52
4501000 SARATOGA HOSPITAL $588.30 $65.00 $233.85 $187.52
6120700 SOLDIERS AND SAILORS MEM HOSP $583.35 $56.51 $188.38 $187.52
2950001 SOUTH NASSAU COMMUNITIES $619.01 $121.29 $270.66 $254.96
5154000 SOUTHSIDE HOSPITAL $672.74 $53.32 $294.15 $254.96
7000014 ST BARNABAS HOSPITAL $659.82 $98.30 $288.50 $254.96
5157003 ST CATHERINE OF SIENA $679.87 $58.48 $297.27 $254.96
3202002 ST ELIZABETH MEDICAL CENTER $730.15 $27.55 $235.79 $187.52
7001024 ST JOHNS EPISCOPAL SO SHORE $767.14 $130.91 $335.43 $254.96
0701001 ST JOSEPHS HOSP / ELMIRA $646.44 $10.95 $208.75 $187.52
3301003 ST JOSEPHS HOSP HLTH CTR $624.64 $59.54 $248.29 $187.52
5907002 ST JOSEPHS MEDICAL CENTER $658.41 $56.37 $287.88 $254.96
2801001 ST MARYS HOSP / AMSTERDAM $657.49 $20.80 $212.32 $187.52
7001037 STATE UNIV HOSP / DOWNSTATE $701.08 $274.87 $306.54 $254.96
7004003 STATEN ISLAND UNIV HOSP $654.10 $128.65 $286.00 $254.96
2701005 STRONG MEMORIAL HOSPITAL $635.95 $109.54 $252.79 $187.52
2754001 THE UNITY HOSP OF ROCHESTER $548.01 $57.05 $217.83 $187.52
0427000 TLC HEALTH NETWORK $593.79 $41.03 $191.75 $187.52
0303001 UNITED HEALTH SERVICES INC $599.76 $40.67 $238.40 $187.52
5151001 UNIV HOSP AT STONY BROOK $659.18 $159.47 $288.22 $254.96
3301007 UNIV HOSP SUNY HLTH SCI CTR $649.24 $158.10 $258.07 $187.52
3301003 UPSTATE UNIV HOSP/COMM GEN $654.90 $36.33 $260.32 $187.52
5957001 WESTCHESTER MEDICAL CENTER $732.18 $178.00 $320.14 $254.96
0602001 WOMANS CHRISTIAN ASSOC $645.31 $28.82 $208.39 $187.52
7001045 WOODHULL MEDICAL $653.91 $109.68 $285.92 $254.96
6027000 WYOMING CO COMMUNITY HOSP $675.15 $48.50 $218.03 $187.52