Upper Payment Limit Methodology
Guidance for: This document is intended to provide guidance on standard UPL formulas that a State may use to demonstrate their UPLs and enhanced practitioner
payment limit. Here you will find a crosswalk between the names of variables and the variable numbers as identified in the OMB-approved templates.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 01, 2020
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.