      *********************************************
      *   12/20/2011  RELEASE - V201211           *
      *            Production                     *
      *********************************************
NOTE TO: Shared System Coordinators, MEDICARE Coordinators

SUBJECT:	Outpatient Prospective Payment System (OPPS) Pricer System
         Release, Version 201211
(January 1, 2012)     --ACTION--refer to CMS change request CR #7672

This OPPS Pricer release is the updated version and is designed for
implementaton in conjunction with the current OCE/APC V13.0
lines in the shared claims payment systems on or about 01Jan2012 and
includes the following:
  - Corrected 2012 rates (APC & offets/reductions)
  - Corrected outlier threshold
  - ASP Drug rates effective 01/01/2012 added to APC table
  - Revised pass-through device offset logic to accommodate devices that
    have multiple procedure pairings with different effective and
    termination dates.
  - Revised pass-through offset logic to include the termination date
    as a valid date of service (pass-through contrast agents,
    devices, and radiopharmaceuticals).
  **********************************************


A partitioned data set of the Version 201211 code
(MU00.@BF12390.OPPS.V201211.COBOL) is at the CMS Data Center for users
to obtain by Connect:Direct (Network DataMover).
The 41 members:

1  source program - OPPSCAL.

30 copybooks  - OPPSWINX,OPPSWNXC,OPPSAPCS,OPPSOF02,OPPSOF03,OPPSOF04,
                OPPSOF06 OPPSOF07,OPPSOF08,DEVRED07,DEVRED08,OPPSMH08,
                OPPSPH08,DEVRED09,OPPSMH09,OPPSPH09,SSRFBN09,OPPSPTRH,
                OPPSPTRO,OPPSPTCH,OPPSPTCO,DEVRED10,OPPSMH10,OPPSPH10,
                SSRFBN10,SSRFB10B,OPPSPTDO,DEVRED11,DEVRED12,OPPSMH12

8  databooks  - BASEAPCS,BASEWINX,BASEWNXC,BASEPTRH,BASEPTRO,
                BASEPTCH,BASEPTCO,BASEPTDO

2  text files - copy of this V201211 Release Memorandum
                and a list of the return codes (expanded by user notes)
              - V200MEMO,RTNCODES


If you have any questions concerning this release or any other OPPS
Pricer-related issues, please call Fred Rooke at (404) 562-7205.





                              Tamara E. Howard
                              Computer Specialist/Systems Analyst
                              Division of Data Systems
                              CMS/CMM/PBG/DDS



OPPS Pricer Release V201211 Notes:    Page 1 of 2

Below are brief descriptions of the OPPS Pricer modules in
Version 201211 of the system plus a copy of the Linkage Section and
the CALL statement needed to access the module.

BASEAPCS - human-readable data from which the OPPSAPCS copybook is built

BASEPTCH - human-readable data from which the OPPSPTCH copybook is built

BASEPTCO - human-readable data from which the OPPSPTCO copybook is built

BASEPTDO - human-readable data from which the OPPSPTDO copybook is built

BASEPTRH - human-readable data from which the OPPSPTRH copybook is built

BASEPTRO - human-readable data from which the OPPSPTRO copybook is built

BASEWINX - human-readable data from which the OPPSWINX copybook is built

BASEWNXC - human-readable data from which the OPPSWNXC copybook is built

DEVRED07 - copybook of 2007 device reduction APCs and reduction amounts

DEVRED08 - copybook of 2008 device reduction APCs and reduction amounts

DEVRED09 - copybook of 2009 device reduction APCs and reduction amounts

DEVRED10 - copybook of 2010 device reduction APCs and reduction amounts

DEVRED11 - copybook of 2011 device reduction APCs and reduction amounts

DEVRED12 - copybook of 2012 device reduction APCs and reduction amounts

OPPSAPCS - copybook of APC groups for OPPSCAL,
           expanded to include additional APC groups
OPPSCAL  - source code for OPPS pricing subroutine

OPPSMH08 - copybook of CY 2008 mental health HCPCS

OPPSMH09 - copybook of CY 2009 mental health HCPCS

OPPSMH10 - copybook of CY 2010 mental health HCPCS

OPPSMH12 - copybook of CY 2012 mental health HCPCS

OPPSOF02 - copybook of device APC groups with an offset amount,
           for SI ' H' processing for OPPSCAL for 2002
OPPSOF03 - copybook of device APC groups with an offset amount,
           for SI ' H' processing for OPPSCAL for 2003
OPPSOF04 - copybook of device APC groups with an offset amount,
           for SI ' H' processing for OPPSCAL for 2004, 2005
OPPSOF06 - copybook of device APC groups with an offset amount,
           for SI ' H' processing for OPPSCAL for 2006
OPPSOF07 - copybook of device APC groups with an offset amount,
           for SI ' H' processing for OPPSCAL for 2007
OPPSOF08 - copybook of device APC groups with an offset amount,
           for SI ' H' processing for OPPSCAL for 2008
OPPSPH08 - copybook of CY 2008 partial hospitalization HCPCS

OPPSPH09 - copybook of CY 2009 partial hospitalization HCPCS

OPPSPH10 - copybook of CY 2010 partial hospitalization HCPCS

OPPSPTCH - copybook of pass-through contrast agent hcpcs for OPPSCAL

OPPSPTCO - copybook of pass-through contrast agent offsets for OPPSCAL

OPPSPTDO - copybook of pass-through device offsets for OPPSCAL

OPPSPTRH - copybook of pass-through radiopharm. hcpcs for OPPSCAL

OPPSPTRO - copybook of pass-through radiopharm. offsets for OPPSCAL

OPPSWINX - copybook of wage indices by MSA for OPPSCAL

OPPSWNXC - copybook of wage indices by CBSA for OPPSCAL

RTNCODES - list of OPPS Pricer claim and line level return codes

SSRFBN09 - copybook of CY 2009 state-specific rural floor budget
           neutrality (SSRFBN) factors
SSRFBN10 - copybook of CY 2010 state-specific rural floor budget
           neutrality (SSRFBN) factors: 01/01/2010 - 06/30/2010
SSRFB10B - copybook of CY 2010 state-specific rural floor budget
           neutrality (SSRFBN) factors: 07/01/2010 - 12/31/2010
V200MEMO - copy of this memorandum


This is the LINKAGE SECTION defined in OPPSCAL.


       LINKAGE SECTION.

      ***************************************************************
      *        LAYUP TABLE AREA FOR PROVIDER SPECIFIC RECORD        *
      ***************************************************************

       01  L-PROV-SPEC-AREA.
               05  L-PSF-NPI                    PIC X(08).
               05  L-PSF-NPI-FILLER             PIC X(02).
               05  L-PSF-PROV-OSCAR.
                 10  L-PSF-PROV-ST              PIC X(02).
                 10  L-PSF-PROV-3456            PIC X(04).
               05  L-PSF-EFFDT                  PIC 9(08).
               05  L-PSF-FY-BEGIN-DT            PIC 9(08).
               05  L-PSF-REPORT-DT              PIC 9(08).
               05  L-PSF-TERMDT                 PIC 9(08).
               05  L-PSF-WAIVE-IND              PIC X(01).
               05  L-PSF-FI-NUM                 PIC 9(05).
               05  L-PSF-PROV-TYPE              PIC X(02).
               05  L-PSF-SPCL-LOCATION-IND      PIC X(01).
               05  L-PSF-WGIDX-RECLASS          PIC X(01).
               05  L-PSF-GEO-MSA                PIC X(04).
               05  L-PSF-WI-MSA                 PIC X(04).
               05  L-PSF-COLA                   PIC 9V9(03).
               05  L-PSF-STATE-CODE             PIC 9(02).
               05  L-PSF-TOPS-INDICATOR         PIC X(01).
               05  L-PSF-HOSP-QUAL-IND          PIC X(01).
               05  FILLER                       PIC X(01).
               05  L-PSF-OPCOST-RATIO           PIC 9V9(03).
               05  L-PSF-GEO-CBSA               PIC X(05).
               05  L-PSF-WI-CBSA                PIC X(05).
               05  L-PSF-SPEC-WGIDX             PIC 9(02)V9(04).
               05  L-PSF-SPEC-PYMT-IND          PIC X(01).
               05  L-PSF-APC-LINE-CNT           PIC 9(04).
               05  L-PSF-APC-TABLE     OCCURS 999 TIMES
                        DEPENDING ON L-PSF-APC-LINE-CNT.
                   10  L-PSF-APC                PIC X(04).
                   10  L-PSF-RED-COIN           PIC 9(04)V99.


      ***************************************************************   00000100
      *  INPUT RECORD FROM THE OCE/STANDARD SYSTEM                  *
      *-------------------------------------------------------------*
      * BELOW ARE THE VARIABLES THAT WILL BE PASSED                 *
      * TO PRICER FROM THE OCE BEGINNING OCT. 1, 2005 THERE WILL BE *
      *    - INCREASED SIZE OF SERVICE AND PAYMENT - 1 TO 2 BYTES   *
      *    - INCREASED SIZE OF PYMT ADJUSTMENT FLAG - 1 TO 2 BYTES  *
      *    CY 2009 EDITS - MADE 11/10/2008:                         *
      *    - INCREASED SIZE OF SERVICE UNITS - 7 TO 9 BYTES         *
      *    - ADDED COMPOSITE ADJUSTMENT FLAG - 2 BYTES              *
      ***************************************************************
       01  OPPS-LINE-CNT                  PIC 9(08) COMP.
       01  OCE-DATA.
           05  OPPS-OCE-LINE OCCURS 450 TIMES
                     DEPENDING ON OPPS-LINE-CNT.
               10  OPPS-HCPCS.
                 15  OPPS-ALPHA           PIC X(01).
                 15  FILLER               PIC X(04).
               10  OPPS-GRP.
                 15  FILLER               PIC X(01).
                 15  OPPS-APC             PIC X(04).
               10  OPPS-HCPCS-APC         PIC X(05).
               10  OPPS-SRVC-IND          PIC X(02).
               10  OPPS-PYMT-IND          PIC X(02).
               10  OPPS-DISC-FACT         PIC 9(01).
               10  OPPS-LITEM-DR-FLAG     PIC X(01).
               10  OPPS-PKG-FLAG          PIC X(01).
               10  OPPS-PYMT-ADJ-FLAG     PIC X(02).
               10  OPPS-SITE-SRVC-FLAG    PIC X(01).
               10  OPPS-SRVC-UNITS        PIC 9(09).
               10  OPPS-SUB-CHRG          PIC 9(08)V99.
               10  OPPS-LITEM-ACT-FLAG    PIC X(01).
               10  OPPS-COMP-ADJ-FLAG     PIC X(02).
       01  L-SERVICE-FROM-DATE       PIC 9(08).
       01  BENE-DEDUCT               PIC 9(03)V9(02).
       01  BENE-BLOOD-PINTS          PIC 9(01).


      ***************************************************************
      *   BELOW ARE THE VARIABLES THAT WILL BE PASSED BACK          *
      *   TO SS ASSOCIATED WITH THE BILL BEING PROCESSED            *
      *   - EFF. 04/01/2002 CALCULATE LINE ITEM OUTIER PAYMENT      *
      ***************************************************************
       01  A-ADDITIONAL-VARIABLES.
           05  A-CALC-VERS             PIC X(07).
           05  A-TOTAL-CLM-DEDUCT      PIC 9(03)V9(02).
           05  A-OUTLIER-PYMT          PIC 9(07)V9(02).
           05  A-TOT-CLM-PYMT          PIC 9(07)V9(02).
           05  A-TOT-CLM-CHRG          PIC 9(07)V9(02).
           05  A-CLM-RTN-CODE          PIC 9(02).
           05  A-MSA                   PIC X(04).
           05  A-CBSA                  PIC X(05).
           05  A-WINX                  PIC S9V9(04).
           05  A-BLOOD-PINTS-USED      PIC 9(01).
           05  A-BLOOD-DEDUCT-DUE      PIC 9(05)V9(02).
           05  A-LINE-ITEMS OCCURS 450 TIMES
                   DEPENDING ON OPPS-LINE-CNT.
             10  A-LITEM-PYMT          PIC 9(07)V9(02).
             10  A-LITEM-REIM          PIC 9(07)V9(02).
             10  A-TOTAL-LN-DEDUCT     PIC 9(03)V9(02).
             10  A-ADJ-COIN            PIC 9(05)V9(02).
             10  A-RED-COIN            PIC 9(05)V9(02).
             10  A-BLOOD-LN-DEDUCT     PIC 9(05)V9(02).
             10  A-RETURN-CODE         PIC 9(02).

       01  OCE-IN-DATE.
           05  OCE-IN-LINES OCCURS 450 TIMES.
              10  FILLER               PIC X(15).
              10  OPPS-LITEM-DOS       PIC 9(08).
              10  FILLER               PIC X(23).
      *       10  FILLER               PIC X(21). CHANGED 12/2/2008

   Data Descriptions:
     A-CALC-VERS             - OPPSCAL release version
     A-TOTAL-CLM-DEDUCT      - Total deductible applied the claim
     A-OUTLIER-PYMT          - Outlier payment for the claim
                               associated with the OPPS lines
     A-TOT-CLM-PYMT          - Total claim payment amount used to
                               calculate the outlier amount
     A-TOT-CLM-CHRG          - Total claim charge amount used to
                               calculate the outlier amount
     A-CLM-RTN-CODE          - Claim level return code
     A-MSA                   - MSA for claim
     A-CBSA                  - CBSA for claim
     A-WINX                  - Wage Index for claim
     *********************************
     * A-LINE-ITEMS OCCURS 450 TIMES *
     *    DEPENDING ON OPPS-LINE-CNT.*
     *********************************
       A-LITEM-PYMT          - Total adjusted line payment
       A-LITEM-REIM          - Medicare program payment amount
       A-TOTAL-LN-DEDUCT     - Total deductible applied to the line
       A-ADJ-COIN            - Adjusted coinsurance amount
       A-RED-COIN            - Provider elected coinsurance or
                               minimum coinsurance allowed ; which
                               ever is greatest
       A-BLOOD-LN-DEDUCT     - Total blood deductible applied
                               to the line
       A-RETURN-CODE         - Line level retun code



   ***************************************************************
   *    PROCESSING:                                              *
   *        Below is the CALL STATEMENT and variables listed     *
   *             required by the OPPSCAL module.                 *
   ***************************************************************

       CALL OPPSCAL USING OPPS-LINE-CNT
                          OCE-DATA
                          A-ADDITIONAL-VARIABLES
                          L-PROV-SPEC-AREA
                          L-SERVICE-FROM-DATE
                          BENE-DEDUCT
                          BENE-BLOOD-PINTS
                          OCE-IN-DATE.

