Hospital Base Rates and Rate Codes

Revised July 1, 2016.

Article 28 Rate Codes by Hospital Setting
SETTING SERVICE VISIT RATE CODE EPISODE RATE CODE
HOSPITAL AMBULATORY SURGERY 1401  
HOSPITAL AMBULATORY SURGERY - OUT OF STATE 1416  
HOSPITAL DOH OPD APG ART 28 INTEGRATED SVC (DUAL LIC)   1594
HOSPITAL DOH OPD APG ART 28 INTEGRATED SVC (SINGLE LIC)   1104
HOSPITAL EMERGENCY DEPARTMENT   1402
HOSPITAL EMERGENCY DEPARTMENT - OUT OF STATE   1419
HOSPITAL MA CVRD NON-CARE CVRD SRVC FOR DUAL-OPD-APG MR/DD/TBI 1054  
HOSPITAL MA CVRD NON-MEDICARE CVRD SRVCS FOR DUALS-OPD-APG 1126  
HOSPITAL OPD - MR/DD/TBI PATIENT 1501* 1489*
HOSPITAL OPD CLINIC 1400 1432
HOSPITAL OPD CLINIC - OUT OF STATE 1413 1441
HOSPITAL SCHOOL BASED HEALTH PROJECT 1444 1450

* rate codes 1501, & 1489 are to be used for those Medicaid Members with recipient restriction codes 81 or 95


Article 32 Rate Codes by Hospital Setting
SETTING SERVICE VISIT RATE CODE EPISODE RATE CODE
HOSPITAL OASAS - ARTICLE 32 CLINIC MEDICAL VISIT 1528 1552
HOSPITAL OASAS - HOSPITAL ARTICLE 32 OP REHAB MEDICAL VISIT 1561 1558
HOSPITAL OASAS - HOSPITAL MMTP (WEEKLY) 1567 1531
HOSPITAL OASAS - MMTP CLINIC MEDICAL VISIT   1555
HOSPITAL OASAS OPD APG ART 32 INTEGRATED SVC (DUAL LIC) 1132  
HOSPITAL OASAS OPD APG ART 32 INTEGRATED SVC (SINGLE LIC) 1118  
HOSPITAL OASAS OPD APG MMTP INTEGRATED SVC (DUAL LIC) 1134  
HOSPITAL OASAS OPD APG MMTP INTEGRATED SVC (SINGLE LIC) 1120  

Article 31 Rate Codes by Hospital Setting
SETTING SERVICE VISIT RATE CODE EPISODE RATE CODE
HOSPITAL OMH - HOSP ARTICLE 31 CLINIC (SED) (UT EXEMPT) APG 1142  
HOSPITAL OMH - HOSP ARTICLE 31 CLINIC (UT EXEMPT) APG 1140  
HOSPITAL OMH - HOSPITAL ARTICLE 31 CLINIC 1516  
HOSPITAL OMH - HOSPITAL ARTICLE 31 CLINIC - OFF-SITE 1519  
HOSPITAL OMH - HOSPITAL ARTICLE 31 CLINIC - OFF-SITE (SED) 1525  
HOSPITAL OMH - HOSPITAL ARTICLE 31 CLINIC (CRISIS) 1576  
HOSPITAL OMH - HOSPITAL ARTICLE 31 CLINIC (CRISIS) (SED) 1582  
HOSPITAL OMH - HOSPITAL ARTICLE 31 CLINIC (SED) 1522  
HOSPITAL OMH - HOSPITAL ARTICLE 31 MEDICAL VISIT 1588  
HOSPITAL OMH - HOSPITAL ARTICLE 31 MEDICAL VISIT (SED) 1591  
HOSPITAL OMH OPD APG ART 31 INTEGRATED SVC (DUAL LIC) 1122  
HOSPITAL OMH OPD APG ART 31 INTEGRATED SVC (SINGLE LIC) 1110  
HOSPITAL OMH OPD APG ART 31 INTEGRATED SVC-SED (DUAL LIC) 1124  
HOSPITAL OMH OPD APG ART 31 INTEGRATED SVC-SED (SINGLE LIC) 1112  

Article 16 Rate Codes by Hospital Setting
SETTING SERVICE VISIT RATE CODE EPISODE RATE CODE
HOSPITAL OMRDD - HOSPITAL ARTICLE 16 CLINIC 1534  
HOSPITAL OMRDD - HOSPITAL ARTICLE 16 CLINIC - OFF SITE 1537