FINANCIALLY DISTRESSED HOSPITAL OUTPATIENT RATE ADD-ONS

EFFECTIVE 4/1/2023 - 3/31/2024

  • Add-ons also available in Portable Document Format (PDF)
Critical Access Hospital Rate Add-ons (4/1/2023 - 3/31/2024) Clinic Ambulatory Surgery Emergency Department
Operating Certificate Medicaid ID NPI Hospital Name Add-on Payment Per Visit Add-on Payment Per Visit Add-on Payment Per Visit
2238700 03000635 1053497388 Carthage Area Hospital $388.00 $2,475.00 $500.00
2238700 03000662 1104234376 Carthage Area Hospital $388.00 $2,475.00 $500.00
2238700 03000699 1518178409 Carthage Area Hospital $388.00 $2,475.00 $500.00
2238700 03000759 1801007364 Carthage Area Hospital $388.00 $2,475.00 $500.00
2238700 03000768 1982815445 Carthage Area Hospital $388.00 $2,475.00 $500.00
4458701 02994847 1235184649 Clifton-Fine Hospital $388.00 $2,475.00 $500.00
4720700 00302429 1689741985 Cobleskill Regional Hospital $388.00 $2,475.00 $500.00
4720700 03000488 1891862579 Cobleskill Regional Hospital $388.00 $2,475.00 $500.00
2625700 00354229 1932100393 Community Memorial Hospital $388.00 $2,475.00 $500.00
2625700 03001567 1992707608 Community Memorial Hospital $388.00 $2,475.00 $500.00
0226700 00354238 1407839822 Cuba Memorial Hospital $388.00 $2,475.00 $500.00
0226700 03196283 1770738791 Cuba Memorial Hospital $388.00 $2,475.00 $500.00
1229700 00347571 1417940719 Delaware Valley Hospital $388.00 $2,475.00 $500.00
5526700 02094860 1073525341 Ellenville Regional Hospital $388.00 $2,475.00 $500.00
5263700 02961773 1649251554 Garnet Health Medical Center - Catskills - G Hermann $388.00 $2,475.00 $500.00
4423701 00354256 1023449709 Gouverneur Hospital $388.00 $2,475.00 $500.00
4423701 03001576 1629409925 Gouverneur Hospital $388.00 $2,475.00 $500.00
2424700 00354370 1518380732 Lewis County General Hospital $388.00 $2,475.00 $500.00
2424700 03001627 1619390838 Lewis County General Hospital $388.00 $2,475.00 $500.00
2424700 05814397 1427565126 Lewis County General Hospital $388.00 $2,475.00 $500.00
2129700 00310870 1548220908 Little Falls Hospital $388.00 $2,475.00 $500.00
2129700 03000786 1558321919 Little Falls Hospital $388.00 $2,475.00 $500.00
1226701 00279387 1164473039 Margaretville Hospital $388.00 $2,475.00 $500.00
1226701 03000451 1740233840 Margaretville Hospital $388.00 $2,475.00 $500.00
3622700 00310898 1366573131 Medina Memorial Hospital $388.00 $2,475.00 $500.00
3622700 03000819 1437280955 Medina Memorial Hospital $388.00 $2,475.00 $500.00
3622700 03000846 1609873520 Medina Memorial Hospital $388.00 $2,475.00 $500.00
1254700 00354081 1447311030 O'Connor Hospital $388.00 $2,475.00 $500.00
1254700 03001530 1801975156 O'Connor Hospital $388.00 $2,475.00 $500.00
1254700 03001549 1891728192 O'Connor Hospital $388.00 $2,475.00 $500.00
2221700 02392854 1003814641 River Hospital $388.00 $2,475.00 $500.00
2221700 03011387 1821022781 River Hospital $388.00 $2,475.00 $500.00
4823700 00363144 1639150477 Schuyler Hospital $388.00 $2,475.00 $500.00
4823700 03002522 1740364181 Schuyler Hospital $388.00 $2,475.00 $500.00
6120700 02994705 1215044516 Soldiers And Sailors Memorial Hospital $388.00 $2,475.00 $500.00
6120700 02984430 1285777086 Soldiers And Sailors Memorial Hospital $388.00 $2,475.00 $500.00
6120700 02984449 1093858896 Soldiers And Sailors Memorial Hospital $388.00 $2,475.00 $500.00
1552701 00354274 1407061591 Univ of Vt Hlth Network-Elizabethtown Comm Hospital $388.00 $2,475.00 $500.00
1552701 03001585 1891785184 Univ of Vt Hlth Network-Elizabethtown Comm Hospital $388.00 $2,475.00 $500.00
Sole Community Hospital Rate Add-ons (4/1/2023 - 3/31/2024) Clinic Ambulatory Surgery Emergency Department
Operating Certificate Medicaid ID NPI Hospital Name Add-on Payment Per Visit Add-on Payment Per Visit Add-on Payment Per Visit
1623001 00363213 1245446533 Adirondack Medical Center $151.00 $2,071.00 $213.00
1623001 03002559 1699709576 Adirondack Medical Center $151.00 $2,071.00 $213.00
1623001 03002568 1750395562 Adirondack Medical Center $151.00 $2,071.00 $213.00
1623001 03002586 1831226273 Adirondack Medical Center $151.00 $2,071.00 $213.00
1623001 03002595 1922135367 Adirondack Medical Center $151.00 $2,071.00 $213.00
0501000 00347553 1093712911 Auburn Community Hosp $151.00 $2,071.00 $213.00
0501000 03001223 1205801362 Auburn Community Hosp $151.00 $2,071.00 $213.00
3801000 03000415 1578529954 A.O. Fox Memorial Hospital $151.00 $2,071.00 $213.00
0601000 00381439 1215917224 Brooks-TLC Hospital System $151.00 $2,071.00 $213.00
0601000 02995848 1487738886 Brooks-TLC Hospital System $151.00 $2,071.00 $213.00
4429000 00354196 1568548782 Canton-Potsdam Hospital $151.00 $2,071.00 $213.00
4429000 03131160 1114104445 Canton-Potsdam Hospital $151.00 $2,071.00 $213.00
5401001 00332729 1144397100 Cayuga Medical Center at Ithaca $151.00 $2,071.00 $213.00
5401001 03001067 1164547303 Cayuga Medical Center at Ithaca $151.00 $2,071.00 $213.00
5401001 03001076 1366519795 Cayuga Medical Center at Ithaca $151.00 $2,071.00 $213.00
5401001 03001085 1962422733 Cayuga Medical Center at Ithaca $151.00 $2,071.00 $213.00
5401001 03001094 1982771325 Cayuga Medical Center at Ithaca $151.00 $2,071.00 $213.00
0824000 00314723 1770593956 Chenango Memorial Hospital $151.00 $2,071.00 $213.00
4401000 02997831 1891753034 Claxton-Hepburn Medical Center $151.00 $2,071.00 $213.00
4401000 02966989 1427119486 Claxton-Hepburn Medical Center $151.00 $2,071.00 $213.00
4401000 02966865 1346301389 Claxton-Hepburn Medical Center $151.00 $2,071.00 $213.00
4401000 02966874 1396805073 Claxton-Hepburn Medical Center $151.00 $2,071.00 $213.00
4401000 07014579 1447843636 Claxton-Hepburn Medical Center $151.00 $2,071.00 $213.00
5263000 02997051 1710977012 Garnet Health Medical Center - Catskills $151.00 $2,071.00 $213.00
1101000 00279176 1033117635 Guthrie Cortland Medical Center $151.00 $2,071.00 $213.00
1101000 03000424 1396743993 Guthrie Cortland Medical Center $151.00 $2,071.00 $213.00
1101000 03000433 1487655056 Guthrie Cortland Medical Center $151.00 $2,071.00 $213.00
1101000 03000442 1740287531 Guthrie Cortland Medical Center $151.00 $2,071.00 $213.00
0228000 00354403 1720030703 Jones Memorial Hospital $151.00 $2,071.00 $213.00
3824000 00305000 1063572733 Mary Imogene Bassett Hospital $151.00 $2,071.00 $213.00
3824000 03000584 1093897910 Mary Imogene Bassett Hospital $151.00 $2,071.00 $213.00
3824000 03000593 1780600577 Mary Imogene Bassett Hospital $151.00 $2,071.00 $213.00
3824000 03000608 1851452890 Mary Imogene Bassett Hospital $151.00 $2,071.00 $213.00
3824000 06428528 1700198652 Mary Imogene Bassett Hospital $151.00 $2,071.00 $213.00
4402001 03001636 1972604460 Massena Hospital $151.00 $2,071.00 $213.00
0401001 00354632 1225083074 Olean General Hospital $151.00 $2,071.00 $213.00
0401001 03001778 1699715904 Olean General Hospital $151.00 $2,071.00 $213.00
0401001 03001787 1700825262 Olean General Hospital $151.00 $2,071.00 $213.00
0401001 03001796 1740333681 Olean General Hospital $151.00 $2,071.00 $213.00
3702000 02997771 1871678458 Oswego Hospital $151.00 $2,071.00 $213.00
2201000 00354316 1093722068 Samaritan Medical Center $151.00 $2,071.00 $213.00
2201000 03001594 1598713745 Samaritan Medical Center $151.00 $2,071.00 $213.00
2201000 03001609 1801902713 Samaritan Medical Center $151.00 $2,071.00 $213.00
5002001 00363162 1013985399 St James Hospital $151.00 $2,071.00 $213.00
1624000 00354114 1114954682 Univ of Vt Hlth Network-Alice Hyde Medical Center $151.00 $2,071.00 $213.00
0901001 00318814 1033270699 Univ of Vt Hlth Network-Champlain Valley Physicians $151.00 $2,071.00 $213.00
0901001 03000882 1487785382 Univ of Vt Hlth Network-Champlain Valley Physicians $151.00 $2,071.00 $213.00
6027000 00310889 1316924913 Wyoming County Community Hospital $151.00 $2,071.00 $213.00
6027000 03000795 1437136843 Wyoming County Community Hospital $151.00 $2,071.00 $213.00
6027000 03000800 1639156045 Wyoming County Community Hospital $151.00 $2,071.00 $213.00