> For the complete documentation index, see [llms.txt](https://docs.payerset.com/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://docs.payerset.com/using-the-payerset-platform/data-dictionary/medicare-data/medicare-outpatient-data.md).

# OPPS - Outpatient Prospective Payment System

Hospital outpatient payment data by provider and HCPCS, including APC classification, national rates, wage indexes, and adjusted Medicare rates.

Select **OPPS - Outpatient Prospective Payment System** in the Medicare dataset picker to work with this data. There is one row per hospital outpatient provider and HCPCS code.

{% hint style="warning" %}
Packaged status indicators carry no separate payment. Exclude them when computing percent of Medicare, or the denominator will be understated.
{% endhint %}

### Fields

| Field Name          | UI Name           | Description / Sample Value                                                                                                                                                                         |
| ------------------- | ----------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| NPI                 | NPI               | Unique 10-digit National Provider Identifier of the hospital outpatient provider. e.g. `1003185455`                                                                                                |
| CCN                 | CCN               | CMS Certification Number for the hospital or facility, also known as a PTAN. e.g. `400104`                                                                                                         |
| HCPCS\_Code         | HCPCS Code        | Healthcare Common Procedure Coding System code. e.g. `22600`                                                                                                                                       |
| Status\_Indicator   | Status Indicator  | OPPS status indicator determining payment status and bundling logic. e.g. `J1` (comprehensive APC), `T` (separately payable), `N` (packaged)                                                       |
| APC                 | APC               | Ambulatory Payment Classification group the HCPCS maps to. Used to group HCPCS into weight levels. e.g. `5116`                                                                                     |
| Relative\_Weight    | Relative Weight   | APC relative payment weight — the resource intensity of the APC relative to the average OPPS service. Used to determine the payment rate when combined with the conversion factor. e.g. `195.9590` |
| National\_Rate      | National Rate     | Unadjusted national base payment rate. Calculated by multiplying the OPPS conversion factor by the APC weight. e.g. `$17,913.59`                                                                   |
| Wage\_Index         | Wage Index        | Geographic wage index multiplier applied to the labor portion, based on CBSA or CCN. e.g. `0.3382`                                                                                                 |
| Wage\_Index\_Source | Wage Index Source | Provenance of the wage index used for this provider — CBSA assignment versus rural floor or another CMS special rule. e.g. `CCN`                                                                   |
| Medicare\_Rate      | Medicare Rate     | Final wage-adjusted Medicare reimbursement rate. This is the amount paid for a given HCPCS code for a specific provider in isolation. e.g. `$10,800.46`                                            |

### How the rate is calculated

The national rate comes from the APC weight, and the Medicare rate wage-adjusts the labor portion of it:

```
National Rate = OPPS Conversion Factor × APC Relative Weight
Medicare Rate = National Rate × ((0.6 × Wage Index) + 0.4)
```

Only 60% of the national rate is treated as labor and exposed to the wage index; the remaining 40% is not adjusted.


---

# Agent Instructions
This documentation is published with GitBook. GitBook is the documentation platform designed so that both humans and AI agents can read, navigate, and reason over technical content effectively. Learn more at gitbook.com.

## Querying This Documentation
If you need additional information that is not directly available in this page, you can query the documentation by asking a question.

Perform an HTTP GET request on the following URL with the `ask` and `goal` query parameters:

```
GET https://docs.payerset.com/using-the-payerset-platform/data-dictionary/medicare-data/medicare-outpatient-data.md?ask=<question>&goal=<user_goal>
```

`ask` is the immediate question: it should be specific, self-contained, and written in natural language.
`goal` is what the user is ultimately trying to achieve, the reason they need the answer. Sharing it helps GitBook give you a better, more relevant answer. A goal is most helpful when it describes the outcome the user wants rather than restating the question. For example, with `ask=how do I create an API token`, a goal like `automate deployments from our CI pipeline` lets GitBook tailor the answer to that use case.

The response will contain a direct answer to the question and relevant excerpts and sources from the documentation.

Use this mechanism when the answer is not explicitly present in the current page, you need clarification or additional context, or you want to retrieve related documentation sections.