US · guidance
CMS Pub. 100-04, ch. 4, § 250.7
Payment for Outpatient Services Furnished by an Indian Health
Service (IHS) or Tribal CAH
(Rev. 231, Issued 07-23-04, Effective: 01-01-04/Implementation: 01-03-05)
The IHS or Tribal CAHs are paid for outpatient services based on a facility specific visit
rate that is established on a yearly basis from prior year cost report information.
Payment for outpatient IHS or Tribal CAH services is paid at 80% of the facility specific
outpatient visit rate for both facilities electing Standard Method (I) and Optional Method
(II) billing. IHS or Tribal CAHs will follow the billing methodology for the billing
method that is chosen. Standard Method (I) is found in §250.1 and Optional Method (II)
is found in §250.2 of this chapter. Facilities billing under the Optional Method (II) will
follow the methodology for HPSA and Scarcity payments as outlined in §250.2 of this
chapter. Outpatient services provided at IHS or Tribal CAHs should be billed on an 85X
type of bill.
Effective for cost reporting periods beginning on or after January 1, 2004, payment for
outpatient IHS or Tribal CAH outpatient services will be made at 101% of the facility
specific outpatient visit rate less applicable Part B deductible and coinsurance amounts.
History
(Rev. 231, Issued 07-23-04, Effective: 01-01-04/Implementation: 01-03-05)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
9b3159a78db21dde940588d9013fcb90e80a331be37779885d45df208691af7f
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