Pursuant to the 2020 Hospital Outpatient Prospective Payment System (OPPS) rule issued by Centers for Medicare and Medicaid Services (CMS), all UPMC hospital are providing online access to a Machine-Readable file of Items and Services. “Machine-readable” means that the data file can be easily processed by a computer. Consistent with these regulations issued by CMS, this file will be updated at least annually.
For each hospital item or service provided to patients, the Machine Readable File of Items and Services specifies the hospital standard (gross) charge, discounted cash price (for an individual who pays cash), and the minimum and maximum charge that a hospital has negotiated with a third-party payer. Additionally, this file contains payer-specific negotiated charge amounts as required by CMS.
It is important to note that contracts negotiated between hospitals and payers use many different, and frequently unique, reimbursement methodologies. Hospital reimbursements for clinical services, i.e., charges, may be conditionally paid based on other services provided, or bundled into the payment for other services. Reimbursements also may vary due to other negotiated, complex criteria specific to particular payer contracts. Consequently, using the Machine Readable File of Items and Services to conduct comparisons of contracted payment rates for specific line items across payers may not accurately reflect total contracted reimbursement rates.
The links below can be used to access the Machine-Readable File of Items and Services for each UPMC Hospital:
UPMC Altoona Hospital - Machine Readable File
UPMC Bedford Hospital - Machine Readable File
UPMC Carlisle Hospital - Machine Readable File
UPMC Chautauqua Hospital - Machine Readable File
UPMC Children's Hospital of Pittsburgh - Machine Readable File
UPMC Cole Hospital - Machine Readable File
UPMC Community Osteopathic Hospital - Machine Readable File
UPMC East Hospital - Machine Readable File
UPMC Hamot Hospital - Machine Readable File
UPMC Hanover Hospital - Machine Readable File
UPMC Harrisburg Hospital - Machine Readable File
UPMC Horizon Hospital - Machine Readable File
UPMC Jameson Hospital - Machine Readable File
UPMC Kane - Machine Readable File
UPMC Lititz Hospital - Machine Readable File
UPMC Magee-Womens Hospital - Machine Readable File
UPMC McKeesport Hospital - Machine Readable File
UPMC Memorial Hospital - Machine Readable File
UPMC Mercy Hospital - Machine Readable File
UPMC Muncy Valley Hospital - Machine Readable File
UPMC Northwest Hospital - Machine Readable File
UPMC Passavant Hospital - Machine Readable File
UPMC Presbyterian Shadyside Hospital - Machine Readable File
UPMC Somerset - Machine Readable File
UPMC St. Margaret Hospital - Machine Readable File
UPMC Wellsboro Hospital - Machine Readable File
UPMC West Store Hospital - Machine Readable File
UPMC Western Maryland Hospital - Machine Readable File
UPMC Western Psychiatric Hospital - Machine Readable File
UPMC Williamsport Hospital - Machine Readable File
