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CMS Transparency in Coverage

Hospital Price Transparency

This technical implementation guide contains data dictionaries, CSV templates, and JSON schema for the machine readable files as required by the Hospital Price Transparency final rules (45 CFR 180).

If you are looking for the technical implementation guide for the machine readable files required by the Transparency in Coverage final rules (85 FR 72158), please go to https://github.com/CMSgov/price-transparency-guide.

                          

Overview

The hospital price transparency requirements are codified in regulations at 45 CFR Part 180 and applies to facilities that meet the definition of hospital (defined at 45 CFR § 180.20) and that are not otherwise excepted (see 45 CFR § 180.30(b)). Hospitals must make public their standard charges online in two ways:

  1. A machine-readable file containing a list of all standard charges for all items and services as provided in § 180.50, and;
  2. A consumer-friendly list of standard charges for a limited set of shoppable services as provided in § 180.60.

This GitHub repository addresses only a subset of the requirements for the comprehensive MRF as specified at 45 CFR § 180.50, as amended by the CY2024 OPPS ASC Final Rule.

For information on the consumer-friendly display of shoppable services, refer to 10 Steps to a Consumer Friendly Display of Shoppable Services.

Additional Resources

Users should review the final rule(s) in their entirety as well as review any clarifying guidance provided on the Hospital Price Transparency Resources webpage to ensure compliance.

  • Github Issues - Where people discuss issues related to the project.
  • Github Discussions - Use these channels for conversational topics (for example, "How do I…" or "What do you think about…" instead of bug reports or feature requests).
  • Hospital Price Transparency Tools - Link to webpage of tools to support hospitals in meeting the accessibility and MRF requirements including a MRF File Naming Wizard, a TXT File Generator, and a Validator V2.0 that tests against the required CMS template and data specifications.

Before posting a comment, issue, or question, please search through existing discussions and issues. There is a good chance that the topic in questions is already being discussed.

Policy questions can be directed to: [email protected]. Hospitals undergoing an enforcement action may direct questions to: [email protected].

CMS Template Technical Requirements

This repository houses the required CMS templates, in a CSV “tall”, CSV “wide” and JSON format, and provides the data dictionary, or technical instruction, on how hospitals must encode standard charge information into MRFs.

Schemas

The following is the technical documentation for the allowable formats:

Implementation Timeline

In the CY2024 OPPS/ASC Final Rule, CMS finalized a requirement for hospitals to adopt a CMS template and encode standard charge information for a subset of data elements by July 1, 2024, and all required data elements by January 1, 2025, as noted in the following tables:

CMS Template Required Data Elements and Enforcement Timeline

MRF Information
Requirement Regulation cite Compliance Date
MRF Date 45 CFR § 180.50 (b)(2)(i)(B) July 1, 2024
CMS Template Version 45 CFR § 180.50 (b)(2)(i)(B) July 1, 2024
Affirmation Statement 45 CFR § 180.50 (a)(3)(ii) July 1, 2024
Hospital Information
Requirement Regulation cite Compliance Date
Hospital Name 45 CFR § 180.50 (b)(2)(i)(A) July 1, 2024
Hospital Location(s) 45 CFR § 180.50 (b)(2)(i)(A) July 1, 2024
Hospital Address(es) 45 CFR § 180.50 (b)(2)(i)(A) July 1, 2024
Hospital Licensure Information 45 CFR § 180.50 (b)(2)(i)(A) July 1, 2024
Standard Charges
Requirement Regulation cite Compliance Date
Gross Charge 45 CFR § 180.50 (b)(2)(ii) July 1, 2024
Discounted Cash Price 45 CFR § 180.50 (b)(2)(ii) July 1, 2024
Payer Name 45 CFR § 180.50 (b)(2)(ii)(A) July 1, 2024
Plan Name 45 CFR § 180.50 (b)(2)(ii)(A) July 1, 2024
Standard Charge Method 45 CFR § 180.50 (b)(2)(ii)(B) July 1, 2024
Payer-Specific Negotiated Charge - Dollar Amount 45 CFR § 180.50 (b)(2)(ii)(C) July 1, 2024
Payer-Specific Negotiated Charge - Percentage 45 CFR § 180.50 (b)(2)(ii)(C) July 1, 2024
Payer-Specific Negotiated Charge - Algorithm 45 CFR § 180.50 (b)(2)(ii)(C) July 1, 2024
Estimated Allowed Amount 45 CFR § 180.50 (b)(2)(ii)(C) January 1, 2025
Additional Generic Notes 45 CFR § 180.50 (b)(2)(ii)(C) July 1, 2024
Additional Payer-Specific Notes 45 CFR § 180.50 (b)(2)(ii)(C) July 1, 2024
De-identified Minimum Negotiated Charge 45 CFR § 180.50 (b)(2)(ii) July 1, 2024
De-identified Maximum Negotiated Charge 45 CFR § 180.50 (b)(2)(ii) July 1, 2024
Item & Service Information
Requirement Regulation cite Compliance Date
General Description 45 CFR § 180.50 (b)(2)(iii)(A) July 1, 2024
Setting 45 CFR § 180.50 (b)(2)(iii)(B) July 1, 2024
Drug Unit of Measurement 45 CFR § 180.50 (b)(2)(iii)(C) January 1, 2025
Drug Type of Measurement 45 CFR § 180.50 (b)(2)(iii)(C) January 1, 2025
Coding Information
Requirement Regulation cite Compliance Date
Billing/Accounting Code 45 CFR § 180.50 (b)(2)(iv)(A) July 1, 2024
Code Type 45 CFR § 180.50 (b)(2)(iv)(B) July 1, 2024
Modifiers 45 CFR § 180.50 (b)(2)(iv)(C) January 1, 2025