Hospital Outpatient Prospective Payment System (OPPS)
Guidance for the Hospital Outpatient Prospective Payment System (OPPS). It includes claims for services furnished on or after January 1, 2019 through December 31, 2019 that were received, processed, paid, and passed to the National Claims History file by December 31, 2019.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 06, 2020
NOTICE: Please note that as of April 2009, the OPPS Identifiable Data Set (IDS) is now considered a Limited Data Set (LDS). The former identifiable version of the file is now the only version available. The record layout below lists the data elements included on the new LDS, which include the elements from prior year versions of the IDS. This file has every element that was contained in the 2007 LDS and the 2007 IDS. Requestors should follow the link for Instructions on How to Request LDS Data Files below to obtain this file.
This file contains select claim level data and is derived from 2023 hospital outpatient PPS claims, updated through December 2023, that is, claims for services furnished on or after January 1, 2023 through December 31, 2023 that were received, processed, paid, and passed to the National Claims History file by June 30, 2024. This file includes data elements such as diagnosis codes, bill type, outlier payments, and service revenue payments. This file includes more than 101 million claims for services paid under the OPPS, including multiple and single claims. The record length is 13,603, blocksize is 32,760.
The OPPS LDS file will be available twice a year, once for the NPRM in early summer, and again for the final rule within a month of publication of the OPPS final rule in the Federal Register.
Media: DVD
Cost: $3,000
Data Format: CSV format with SAS® read-in program
Available: Final Rule 2025
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.