Hospital APG Base Rates Using Full APG Investment

Peer Group **Base Rate Code ***Blend Rate Code Capital Rate Code Region 12/01/08 01/01/09 04/01/09 07/01/09 10/01/09 12/01/09 01/01/10 07/01/10 10/01/10 01/01/11 04/01/11 07/01/11 01/01/12 05/01/12 07/01/14 07/01/16 04/01/22 04/01/23
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 $195.59 $195.59 $197.55 $210.39
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 $151.09 $151.09 $152.60 $162.52
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 $183.53 $183.53 $185.37 $197.42
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 $140.52 $140.52 $141.93 $151.16
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 $183.53 $183.53 $185.37 $197.42
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 $140.52 $140.52 $141.93 $151.16
Clinic MR/DD/TBI*[1] 1501 1502 1503 Downstate               $391.14 $376.20 $288.20 $269.36 $278.32 $239.87 $220.23 $220.23 $220.23 $222.43 $236.89
Clinic MR/DD/TBI*[1] 1501 1502 1503 Upstate               $299.47 $289.17 $221.53 $207.05 $213.94 $184.38 $168.63 $168.63 $168.63 $170.32 $181.39
Clinic MR/DD/TBI Episode*[1] 1489 1490 1491 Downstate               $391.14 $376.20 $288.20 $269.36 $278.32 $239.87 $220.23 $220.23 $220.23 $222.43 $236.89
Clinic MR/DD/TBI Episode*[1] 1489 1490 1491 Upstate               $299.47 $289.17 $221.53 $207.05 $213.94 $184.38 $168.63 $168.63 $168.63 $170.32 $181.39
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 $197.38 $197.38 $199.35 $212.31
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 $154.15 $154.15 $155.69 $165.81
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 $183.53 $183.53 $185.37 $197.42
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 $140.52 $140.52 $141.93 $151.16
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 $183.53 $183.53 $185.37 $197.42
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 $140.52 $140.52 $141.93 $151.16

*For Clinic (effective 12/1/2008) & School-Based Health Center [SBHC] (effective 4/1/2009), 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: Clinic rate increased by 20%. Rate increase is effective 7/1/2010.

            Rates not available during this time period.