Expensive Drugs and Devices for Hospitals and ASTCs

A hospital or ambulatory surgical treatment center (ASTC) is eligible for additional payment consideration termed an "outlier payment" for specified expensive drugs and devices provided in conjunction with a procedure from the Ambulatory Procedures Listing (APL). These drugs and devices, along with the associated APL codes, are identified in the table below. The table also identifies the drugs and devices that require prior approval.

• Expensive Drugs and Devices for Hospitals and ASTCs Effective 01/01/14 through 06/30/14
• Expensive Drugs and Devices for Hospitals and ASTCs Effective 07/01/13 through 12/31/13
• Expensive Drugs and Devices for Hospitals and ASTCs Effective 01/01/13 through 06/30/13
• Expensive Drugs and Devices for Hospitals and ASTCs Effective 01/01/12 through 01/01/13
• Expensive Drugs and Devices for Hospitals and ASTCs Effective 07/01/11 through 12/31/11
• Expensive Drugs and Devices for Hospitals and ASTCs Effective 04/01/11 through 06/30/11
• Expensive Drugs and Devices for Hospitals and ASTCs Effective 01/01/11 through 03/31/11
• Expensive Drugs and Devices for Hospitals and ASTCs Effective 09/01/10 through 12/31/10 

• Expensive Drugs and Devices for Hospitals and ASTCs Effective 01/01/10 through 08/31/10
• Expensive Drugs and Devices for Hospitals and ASTCs Effective 11/01/09 through 12/31/09
• Expensive Drugs and Devices for Hospitals and ASTCs Effective 01/01/09 through 10/31/09 (pdf)
• Expensive Drugs and Devices for Hospitals and ASTCs Effective 01/01/08 through 12/31/08 (pdf)
• Expensive Drugs and Devices for Hospitals and ASTCs Effective 01/01/06 through 12/31/07 (pdf)

Outpatient Cost Outlier Worksheet

The Outpatient Cost Outlier Worksheet below can be used to calculate the amount of the additional outlier payment.

• Outpatient Cost Outlier Worksheet for Expensive Drugs and Devices (HFSWEB015) (pdf)