Log InRegister

Reporting And Data

Price Transparency

Latest Update: August 21, 2020
PROVIDE FEEDBACK

Information

Beginning January 1, 2021, Hospitals must post a machine-readable file of their chargemasters including negotiated charges and cash discounts to their websites, along with a consumer-friendly display of shoppable services.

Responsible Party

Who Must Report?

Hospital means an institution in any State in which State or applicable local law provides for the licensing of hospitals, that is licensed as a hospital pursuant to such law or is approved, by the agency of such State or locality responsible for licensing hospitals, as meeting the standards established for such licensing.

Method

How Do I Report?

Standard charges must be posted two ways:

1. Machine Readable File 

Single machine-readable digital file containing the following standard charges for all items and services provided by the hospital: gross chargesdiscounted cash pricespayer-specific negotiated charges, and de-identified minimum and maximum negotiated charges.

For additional details on this requirement refer to 45 CFR §180.50.

2. Consumer-friendly Display of Shoppable Services

Display of at least 300 “shoppable services” (or as many as the hospital provides if less than 300) that a health care consumer can schedule in advance. Must contain plain language descriptions of the services and group them with ancillary services, and provide the discounted cash pricespayer-specific negotiated charges, and de-identified minimum and maximum negotiated charges.

For additional details on this requirement, including the use of price estimator tools, refer to 45 CFR §180.60.

Benefit/Penalty

Why Should I Report?

Beginning January 1, 2021, CMS will monitor and enforce these price transparency requirements. For hospitals that do not comply, CMS may issue a warning notice, request a corrective action plan, and impose a civil monetary penalty (CMP) and publicize the penalty on a CMS website. The maximum daily dollar amount for a CMP to which a hospital may be subject would be $300.

Authority

The legal mandate requiring reporting

In 2010, the Affordable Care Act added a new Section 2718(e) to the Public Health Service Act requiring all hospitals to make public a list of their "standard charges." In previous rulemaking, CMS interpreted the statute to require hospitals to publish their chargemasters in a machine-readable format. That CMS Final Rule can be found here: https://www.govinfo.gov/content/pkg/FR-2018-08-17/pdf/2018-16766.pdf

On June 24th 2019, President Trump issued Executive Order 13877 entitled "Improving Price and Quality Transparency in American Healthcare to Put Patients First" that in rulemaking CMS has required hospitals to expand the machine readable file of the chargemasters and display a consumer-friendly list of shoppable services. That CMS Final Rule can be found here: https://www.govinfo.gov/content/pkg/FR-2019-11-27/pdf/2019-24931.pdf

Notes

Any other pertinent information

Have a question about Hospital Price Transparency? Email the hospital price transparency team.

CMS has specified 70 mandatory shoppable services that must be included if a hospital offers them. Those are:

TABLE 3—Final List of 70 CMS-Specified Shoppable Services

Evaluation & management services 2020 CPT/HCPCS primary code
Psychotherapy, 30 min 90832
Psychotherapy, 45 min 90834
Psychotherapy, 60 min 90837
Family psychotherapy, not including patient, 50 min 90846
Family psychotherapy, including patient, 50 min 90847
Group psychotherapy 90853
New patient office or other outpatient visit, typically 30 min 99203
New patient office of other outpatient visit, typically 45 min 99204
New patient office of other outpatient visit, typically 60 min 99205
Patient office consultation, typically 40 min 99243
Patient office consultation, typically 60 min 99244
Initial new patient preventive medicine evaluation (18-39 years) 99385
Initial new patient preventive medicine evaluation (40-64 years) 99386

 

Laboratory & pathology services 2020 CPT/HCPCS primary code
Basic metabolic panel 80048
Blood test, comprehensive group of blood chemicals 80053
Obstetric blood test panel 80055
Blood test, lipids (cholesterol and triglycerides) 80061
Kidney function panel test 80069
Liver function blood test panel 80076
Manual urinalysis test with examination using microscope 81000 or 81001
Automated urinalysis test 81002 or 81003
PSA (prostate specific antigen) 84153-84154
Blood test, thyroid stimulating hormone (TSH) 84443
Complete blood cell count, with differential white blood cells, automated 85025
Complete blood count, automated 85027
Blood test, clotting time 85610
Coagulation assessment blood test 85730

 

Radiology services 2020 CPT/HCPCS primary code
CT scan, head or brain, without contrast 70450
MRI scan of brain before and after contrast 70553
X-Ray, lower back, minimum four views 72110
MRI scan of lower spinal canal 72148
CT scan, pelvis, with contrast 72193
MRI scan of leg joint 73721
CT scan of abdomen and pelvis with contrast 74177
Ultrasound of abdomen 76700
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus 76805
Ultrasound pelvis through vagina 76830
Mammography of one breast 77065
Mammography of both breasts 77066
Mammography, screening, bilateral 77067

 

Medicine and surgery services 2020 CPT/HCPCS primary code
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities 216
Spinal fusion except cervical without major comorbid conditions or complications (MCC) 460
Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC) 470
Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC) 473
Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC) 743
Removal of 1 or more breast growth, open procedure 19120
Shaving of shoulder bone using an endoscope 29826
Removal of one knee cartilage using an endoscope 29881
Removal of tonsils and adenoid glands patient younger than age 12 42820
Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope 43235
Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope 43239
Diagnostic examination of large bowel using an endoscope 45378
Biopsy of large bowel using an endoscope 45380
Removal of polyps or growths of large bowel using an endoscope 45385
Ultrasound examination of lower large bowel using an endoscope 45391
Removal of gallbladder using an endoscope 47562
Repair of groin hernia patient age 5 years or older 49505
Biopsy of prostate gland 55700
Surgical removal of prostate and surrounding lymph nodes using an endoscope 55866
Routine obstetric care for vaginal delivery, including pre-and post-delivery care 59400
Routine obstetric care for cesarean delivery, including pre-and post-delivery care 59510
Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care 59610
Injection of substance into spinal canal of lower back or sacrum using imaging guidance 62322-62323
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance 64483
Removal of recurring cataract in lens capsule using laser 66821
Removal of cataract with insertion of lens 66984
Electrocardiogram, routine, with interpretation and report 93000
Insertion of catheter into left heart for diagnosis 93452
Sleep study 95810
Physical therapy, therapeutic exercise 97110
DISCLAIMER
Although many of these requirements apply to individual medical professionals and other types of hospitals and health care facilities, the information is presented solely to support Critical Access Hospitals. The reporting requirements and legal mandates on this site are not an exhaustive list and Nevada Rural Hospital Partners, Inc. bears no responsibility or liability for any hospitals' or providers' failure to comply with Federal or State laws or regulations.