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Site-Neutral Cost-Based Payment Amount

CLM_SITE_NTRL_CST_BSD_PYMT_AMT

SECTION 1206(A) OF PUBLIC LAW 113Ö¶7 AMENDED SECTION 1886(M) OF THE ACT TO ESTABLISH PATIENT-LEVEL CRITERIA FOR PAYMENTS UNDER THE LTCH PPS (LONG TERM CARE HOSPITAL PROSPECTIVE PAYMENT SYSTEM) FOR IMPLEMENTATION BEGINNING FOR COST REPORTING PERIODS BEGINNING ON OR AFTER OCTOBER 1, 2015. THE Ó²ITE NEUTRALÔ COST AMOUNT WILL BE PAID FOR PATIENTS DISCHARGED FROM THE LTCH THAT DO NOT MEET CRITERIA TO BE PAID AT THE STANDARD LTCH PPS AMOUNT.

Field Metadata

FHIR Resource
ExplanationOfBenefit
FHIRPath 
ExplanationOfBenefit.adjudication.where(
  category.coding.where(
    system = 'https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication'
  ) and
    category.coding.where(
      code = 'CLM_SITE_NTRL_CST_BSD_PYMT_AMT'
    )
).amount.value
Coverage / Claim Type
  • Inpatient
Source View
V2_MDCR_CLM_INSTNL
Source Column
CLM_SITE_NTRL_CST_BSD_PYMT_AMT
Sources
  • FISS
  • NCH
Profiles
  • CMS

Example 

10.09

bluebutton.cms.gov

official website of the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services.

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