CMS Pub. 100-04, ch. 4, § 260.6

For hospital outpatient departments, the A/B MAC (A) makes payments on a

reasonable cost basis until August 1, 2000 for partial hospitalization services. The

Part B deductible and coinsurance apply. During the year, the A/B MAC (A) will

make payment at an interim rate based on a percentage of the billed charges. At the

end of the year, the hospital will be paid at the reasonable cost incurred in furnishing

partial hospitalization services, based upon the Medicare cost report filed with the A/B

MAC (A).

Beginning with services provided on or after August 1, 2000, payment is made under

the hospital outpatient prospective payment system for partial hospitalization services.

For CAHs, payment is made on a 101% reasonable cost basis regardless of the date of

service.

In CY 2024, payment for non-excepted off-campus hospital-based PHPs will be made

under the MPFS, paying the CMHC per diem rate for APC 5853, for providing up to 3

PHP services per day and APC 5854, for providing 4 or more PHP services per day.

The Part B deductible, if any, and coinsurance apply.