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therefore, Figure 1 illustrates an approach that would not meet the regulatory requirements: Figure 1: Example of an Unacceptable Payer-Specific Negotiated Charge Algorithm Figure 2 provides an example where a hospital provides an algorithm that provides adequate context so that an MRF user may be able to replicate the formula to derive a price

Specifically, we examined the HCPCS code definitions (including CPT code descriptors) and hospital outpatient department billing patterns to determine whether there were categories of codes for which packaging would be appropriate according to existing OPPS packaging policies or a logical expansion of those existing OPPS packaging policies