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 |