Type of Provider or Facility or Service |
Payment Method and Rate |
Ambulance |
Ambulance fee schedule |
Ambulatory Surgery Center (ASC) |
Prospective payment—Ambulatory Payment Classification (APCs) |
Cancer Hospital |
Reasonable cost |
Certified Nurse Midwife (CNM) |
100% of physician fee schedule if billing independently |
Clinical Nurse Specialist (CNS) |
85% of physician fee schedule if billing independently |
Clinical Psychologist (CP) or Independently Practicing Psychologist (IPP) |
100% of physician fee schedule. Limited range of services. |
Certified Registered Nurse Anesthetist (CRNA) or Anesthesia Assistant (AA) |
Anesthetist fee based on anesthesia base and time units |
Clinical social worker (CSW) |
75% of physician fee schedule |
Comprehensive Outpatient Rehab Facility (CORF) |
Fee schedule |
Community Mental Health Center (CMHC) |
Outpatient prospective payment (APC) for partial hospitalization |
Critical Access Hospital (CAH) |
Reasonable cost rule |
Durable Medical Equipment (DME) |
Fee schedule |
End-Stage Renal Disease Facility (ESRD) |
Composite fee schedule |
Federally Qualified Health Center (FQHC) |
Prospective payment |
Home Health Agency (HHA) |
Prospective payment—home health resource groups |
Hospice |
Daily rate based on level of care |
Hospital Inpatient |
Prospective Payment—Diagnosis Related Groups (DRG) |
Hospital Outpatient |
Prospective payment—Ambulatory Payment Classification (APC) |
Hospital Outpatient Lab |
Laboratory fee schedule |
Hospital Outpatient Occupational Therapy |
Fee schedule |
Hospital Outpatient Physical Therapy |
Fee schedule |
Hospital Outpatient Speech Therapy |
Fee schedule |
Independent Diagnostic Testing Facility |
Fee schedule |
Inpatient Psychiatric |
Prospective payment—IPF DRG per diem |
Inpatient Rehab |
Prospective payment IRF based on PAI (Patient Assessment Instrument) |
Nurse Practitioners |
85% of physician fee schedule if billing independently |
Nursing home intermediate care |
Covered by Medicaid—system varies from state to state |
Nursing home skilled care (SNF) |
Prospective payment—Resource Utilization Groups (RUGS) |
Occupational therapy (private practice) |
Fee schedule |
Physical therapy (private practice) |
Fee schedule |
Physician assistant (PA) |
85% if billing under own number with physician supervision |
Physician services |
Physician fee schedule or capitation for managed care |
Rural health clinic (RHC) |
Cost per visit rate |
