(All NJMMIS users must agree to these Terms to continue)
Combined Agreement for use of CPT and CDT codes
Current Procedural Terminology (“CPT”) codes, descriptions and other data only are
copyright 2015 American Medical Association. All rights reserved. CPT is a registered
trademark of the American Medical Association (AMA). Applicable FARS/DFARS apply.
You, your employees, the organization you have the authority to represent and it
employees and agents are authorized to use the CPT and CDT only as contained in
the following authorized materials of the Center for Medicare and Medicaid Services
(CMS) internally within your organization within the United States for the sole
use by yourself, your employees, the organization you are authorized to represent
and its employees and agents. Use is limited to use in Medicare, Medicaid and other
programs administered by CMS. You agree to take all necessary steps to insure that
you, your employees, organization and agents abide by the terms of this agreement.
Any use not authorized herein is prohibited.
CPT and CDT are provided “as is” without warranty of any kind, either expressed
or implied, including but not limited, the implied warranties of merchantability
and fitness for a particular purpose.
The AMA, ADA and CMS disclaim responsibility for any consequences or liability attributable
to or related to any use, non-use or interpretation of information contained or
not contained in this product/file. This agreement will terminate upon notice if
you violate the terms.
The license granted herein is expressly conditioned upon your acceptance of all
terms and conditions contained in this agreement. By clicking the box “I agree”,
you hereby acknowledge that you have read, understood and agreed to all terms and
conditions set forth in this agreement. If acting on behalf of an organization you,
you represent you have the authority to act on their behalf.
Hospital Cost-to-charge ratio is used
to reimburse a hospital for outpatient services on an interim basis. The hospital
is then settled for outpatient services at the lower of cost or charges when their
cost report is audited. The payment is calculated as the cost-to-charge ratio times
billed charges.
Inpatient Hospital Rates and Cost to Charge Ratios
are used in conjunction with DRG weights to determine payment for inpatient services.
The inpatient cost to charge ratio serves as the basis for any cost outlier payment
for Medicaid inpatient services being provided by the hospital.
State-Wide Average Nursing Facility Rate
is the per diem amount used to pay eligible lower level of care days which exceed
the average length of stay for a particular DRG.
Supporting Documentation regarding the calculation of the most current hospital
rate add-on amounts is also available for hospital reference.
