Medicare Opps Rate
medicare_opps_rateWhat does Medicare pay a HOSPITAL OUTPATIENT department for a procedure, device, or drug code? Returns the status indicator, Ambulatory Payment Classification (APC), relative weight, national payment rate, and beneficiary copayment for a HCPCS/CPT code under the Hospital Outpatient Prospective Payment System (OPPS) — the schedule that applies when the same service is billed by a hospital's outpatient department rather than a physician office (medicare_physician_payment) or a lab (medicare_lab_rate). Answers "what does Medicare pay for CPT 33289 in a hospital outpatient setting", "what is the APC for C2624", "is this device on pass-through status", "what is the OPPS payment rate and copay for this code". Flags device_pass_through and drug_or_biological_pass_through — whether the code is CURRENTLY in a CMS pass-through category (status indicator H or G), meaning it is paid separately, outside the normal APC amount, rather than packaged into the procedure it goes with. A packaged code (status indicator N, among others) still has a valid status_indicator but no apc/payment_rate_usd, because OPPS pays for it only as part of whatever procedure it is billed with — that is a normal result, not a missing one. States the fee-schedule YEAR and QUARTER (Q1=Jan, Q2=Apr, Q3=Jul, Q4=Oct) used on every response. Sourced from CMS, OPPS Addendum B.
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| code | Yes | HCPCS or CPT code, e.g. "33289" (CardioMEMS implant procedure) or "C2624" (implantable wireless pulmonary artery pressure sensor). | |
| year | No | Calendar year, e.g. 2026. Omit to use the newest loaded year, which is stated in the response. | |
| quarter | No | Which quarterly release: "Q1".."Q4", or the release month CMS actually uses ("january"/"april"/"july"/"october"). Omit to use the newest loaded quarter for the resolved year. |