Hospital APG Base Rates
Blend Rate Visit / Episode Rate Code
Service Type
Ambulatory Surgery
N/A
N/A
Emergency Department
General Clinic***
1406 / 1433*
General Clinic MR/DD/TBI*** 1502 / 1490*
School‐Based Health Center*** 1445 / 1451*
Capital Add‐
On Visit / Episode Rate Code
1404
1405
1403 / 1434*
1503 / 1491*
1446 / 1452*
**Base Rate Visit / Episode Rate Code
1401
1402
1400 / 1432*
1501 / 1489*
1444 / 1450*
APG Base Rates APG Base Rates APG Base Rates APG Base Rates APG Base Rates APG Base Rates APG Base Rates (Effective December 1, (Effective December 1, (Effective July 1, 2010 (Effective January 1, (Effective January 1, (Effective January 1, (Effective July 1, 2009 2008 thru December 31, 2009 thru December 31, 2009 thru June 30, 2009) thru November 30, 2009)
2010 thru June 30, 2010) thru December 31, 2010)
2011 Forward)
2008)
2009)
Downstate Upstate Downstate Upstate Downstate Upstate Downstate Upstate Downstate Upstate Downstate Upstate Downstate Upstate
$162.53
$132.04
$162.53
$132.04
$156.91
$122.55
$156.91
$122.55
$228.00
$176.13
$215.50
$166.47
$197.29
$152.41
N/A
N/A
$189.15
$152.04
$175.11
$135.27
$175.11
$135.27
$196.94
$153.81
$184.98
$144.47
****
****
$199.00
$199.18
$153.11
$206.48
$158.71
$204.33
$157.07
****
****
$276.38
$219.69
$276.38
$219.69
$258.90
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
$204.33
$157.07
****
****
[1]
[1]
****
****
219.69 276.38 $258.90
$199.00
$199.18
$153.11
$206.48
$158.71
$204.33
$157.07
N/A
N/A
**Schedule provides Base Rates only. For the Blend and Capital Add‐On rates, refer to the Rate by Provider files.
*Episode rate codes effective as follows: General Clinic July 1, 2009, School‐Based Health Center October 1, 2009 & MR/DD/TBI July 1, 2010
***For General Clinic (effective 12/1/2008), School‐Based Health Center (effective 4/1/2009 [1] ) & MR/DD/TBI (effective 7/1/2010), while they share the same base payment rates, please note that their rate codes and effective dates differ.
****Rates are not published. Waiting approval of additional investment by CMS.
Note: At the time CMS approves the additional investments that have been requested by NYS for the Hospital APG rates, the base rates from December 1, 2009 forward will be revised to reflect the increased investment levels.
Hospital Base Rates