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coding for contracted physicians?

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By , July 15, 2015 3:55 pm
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  • coding for contracted physicians?

    http://www.bcbstx.com/provider/pdf/obstetrical_billing_multiple_birth_guidelines.pdf
    Obstetrical Billing & Multiple Birth Guidelines – Blue Cross and Blue …
    Jan 27, 2010 … Services included in the Global OB CPT®' Code 59400 (Vaginal delivery) …
    Physicians will be reimbursed for the initial OB visit separately … The primary
    procedure will be allowed at 100% of the contracted rate, subject to the.

    https://www.locumtenens.com/media/44159/billingforlt.pdf
    How to Bill for Locum Tenens Services – LocumTenens.com
    A recent survey by physician staffing firm LocumTenens.com revealed that 16
    percent of respondents who hire locum tenens physicians do not bill for their
    services. Based on the amount … if this were a new physician. (Some coding
    sites claim … physician's NPI. If you are not contracted, credentialing is usually
    not required.

    http://www.tdi.texas.gov/forms/finmcqa/FIN536.pdf
    HMO Provider Contract Checklist – Texas Department of Insurance
    HMO-PHYSICIAN/PROVIDER CONTRACT CHECKLIST. Although … this
    document, you are advised to consult the Texas Insurance Code, Title 28 of the
    Texas …

    http://www.tuftshealthplan.com/providers/pdf/payment_policies/nonreimbursable_code_list_physicians.pdf
    Nonreimbursable Code List for Physicians – Tufts Health Plan
    1 This list applies to physicians and NPs/PAs who are contracted as PCPs …
    Some procedure codes are either reimbursed as part of a more comprehensive …

    http://www.jpands.org/vol17no2/huntoon.pdf
    CPT Coding – Journal of the American Physicians and Surgeons
    Financing Administration (HCFA) to impose use of the CPT coding system on all
    … by private bounty hunters contracted by CMS to recoup money paid to …

    https://www.aaoms.org/docs/practice_mgmt/beneficiaries_chart.pdf
    May privately contract with Medicare patients, billing the provider's …
    these instances. The –GJ modifier. (opt out physician or practitioner emergency
    or urgent service) must be appended to the procedure code on the claim form.

    http://www.bcbst.com/providers/manuals/bcbstPAM.pdf
    COMMERCIAL Provider Administration Manual – BlueCross …
    Jun 1, 1997 … Retrospective Review. 2. Licensed Physicians Requiring Minimal Supervision …
    HealthCare Common Procedural Coding System (HCPCS) d.

    https://www.bcbsfl.com/DocumentLibrary/Members/MajorMedicalClaimForm.pdf
    InstructIons for fIlIng a MedIcal claIM — Please read … – Florida Blue
    Use a separate claim form for each family member and each physician or
    supplier. 3. … q Type of service and procedure code … Please be aware that if the
    provider or supplier is contracted with Blue Cross and Blue Shield of Florida,
    payment.

    http://www.jacksoncoker.com/Documents/LT-billing.pdf
    Billing for Locum Tenens Physicians – Jackson & Coker
    When billing for a locum tenens physician replacing a current employed
    physician who is unavailable … physician. 6. Claims must contain the modifier Q6
    after the procedure code in box 24D … Non-Contracted Payers—Commercial
    Insurance.

    http://www.tuftshealthplan.com/providers/pdf/payment_policies/physician_assistants.pdf
    Physician Assistant Professional Payment Policy – Tufts Health Plan
    Plan, and to those physician assistants who elect not to sign a contract with Tufts
    … codes. As these revisions are made public, Tufts Health Plan will update its …

    https://www.acponline.org/running_practice/payment_coding/medicare/chronic_care_management_toolkit.pdf
    Chronic Care Management Tool Kit – American College of Physicians
    What Practices Need to Do to Implement and Bill CCM Codes … a contracted
    third party and whose CCM services are generally supervised by the clinician, …

    http://www.pyapc.com/resources/collateral/white-papers/Chronic-Care-Whitepaper-PYA.pdf
    Providing and Billing Medicare for Chronic Care Management – PYA
    The following analysis assumes a family medicine physician with an average …
    physician (or other qualified practitioner), CCM offers providers a bridge over the
    ….. Thus, a provider could contract with a third party to provide non-face-to-face …
    the reported data towards the monthly minimum time for billing the CCM code,.

    https://www.pmphmo.com/documents/providers/marketplace_provider_directory.pdf
    Contracted Providers Directory – Preferred Medical Plan
    Primary Care Physicians. 1. FAMILY PRACTICE. ZIP CODE: 33010. Orlando
    Moreno MD. 2801 W 12 Avenue. Hialeah, FL 33010. (305) 661-6336. Hrs: M,W 9
    -7; …

    https://www.iehp.org/Secure_Site/LogIn/PDF/ACA_FAQ.pdf
    ACA Medi-Cal Primary Care Physician Rate Increase
    calendar year can use billed Medi-Cal codes for the prior month. 3. … Non-
    contracted and out-of-area Physicians are still eligible for the enhanced payment
    as …

    http://www.ashp.org/DocLibrary/Policy/Ambulatory-Care/Pharmacist-Billing-in-Physician-Based-Clinic-FAQ.pdf
    Pharmacist Billing in Physician Based Clinics – ASHP
    Therapy Management (MTM) CPT codes or another preferred mechanism. 2, 3, 4
    … contracted to the physician or Medicare Part B-approved provider.

    http://www.cigna.com/assets/docs/health-care-professionals/853221_NETWORK_NEWS_2Q12.pdf
    Network News For Health Care Professionals Parti… – Cigna
    to include new Current Procedural Terminology (CPT) codes released by the ……
    direct patient referrals to other participating, contracted physicians and facilities …

    http://www.reinhartlaw.com/publications/documents/ea060309hc.pdf
    Hospice Physician Billing for Medically Necessary – Reinhart …
    As the role of medical directors and hospice physicians increases, and direct
    care … or contracted physician, the coding for any physician visits billed by
    hospice …

    http://www.centercare.com/pdf/referenceGuides_nat_803774_2013_2ndqtr.pdf
    Cigna Reference Guide for physicians, hospitals … – Center Care
    For physicians, hospitals, ancillaries, and ….. Credentialing for Physicians and
    Health Care Professionals . ….. Standard Claim Coding/Bundling Methodology.

    http://www.valueoptions.com/providers/Files/pdfs/Suboxone_FAQ.pdf
    Outpatient Detoxification (Detox) Buprenorphine … – ValueOptions
    ValueOptions® contracted physicians may update their participation … Please
    verify what diagnosis codes4 are included in the Outpatient Detox/Buprenorphine
    .

    http://highered.mheducation.com/sites/dl/free/0073402036/639219/Chapter01.pdf
    Chapter 1 Chapter 2 Chapter 3 – McGraw Hill Higher Education
    Patients who come to physicians' practices for medical care are obligated to pay
    for the services they … diagnosis code ethics etiquette …. zation agrees to the
    contract and then offers the coverage to its group members. People who are not …

    what is the ms-drg for 811

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    By , July 15, 2015 5:41 am
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  • what is the ms-drg for 811

    https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareFeeforSvcPartsAB/downloads/DRGdesc08.pdf
    LIST OF DIAGNOSIS RELATED GROUPS (DRGS), FY2008 MS …
    LIST OF DIAGNOSIS RELATED GROUPS (DRGS), FY2008 … MS-DRG Title ……
    Major hematol/immun diag exc sickle cell crisis & coagul w/o CC/MCC. 811. 16.

    http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedQtrlyComp_Newsletter_ICN903687.pdf
    Medicare Quarterly Provider Compliance Newsletter – Centers for …
    Jul 4, 2011 … Other Nervous System Procedures with MCC: MS-DRG 040. ….. validation on the
    following MS-DRGs: … with MCC to 811–Red blood cell.

    https://www.hcup-us.ahrq.gov/db/nation/nis/APS-DRGsDefManualV27Public.pdf
    APS-DRGs® – HCUP
    Instructions for Newborn and Neonatal APS-DRGs® . … APS-DRGs® were
    designed to place a uniform layer of ….. Sickle Cell Anemia – Is the CDRG = 811?

    http://www.eisneramper.com/uploadedFiles/Resource_Center/Articles/Articles/Healthcare-Coding-Documentation-2011.pdf
    Download PDF – EisnerAmper
    Oct 1, 2010 … Currently for MS-DRG 811 y. – Red Blood Cell Disorders with MCC. – Endocrine,
    Nutritional & Metabolic Disorders. • Currently for MS-DRG …

    http://www.hcup-us.ahrq.gov/reports/statbriefs/sb185-Hospital-Intensive-Care-Units-2011.pdf
    Utilization of Intensive Care Services, 2011 – HCUP – Agency for …
    Dec 1, 2014 … (MS-DRG 811, 812). Major joint replacement or reattachment of lower extremity. (
    MS-DRG 469, 470). Simple pneumonia and pleurisy.

    http://www.bcbsil.com/labor/pdf/code_manual/revenue_codes.pdf
    REVENUE CODES
    ACQUISITION OF BODY COMPONENTS,. GENERAL. ORGAN ACQUISIT. 811.
    LIVING DONOR. LIVING DONOR. 812. CADAVER DONOR. CADAVER/DONOR.

    http://www.healthcostinstitute.org/files/HCCI_HCCUR2011_Methodology.pdf
    Methodology – Health Care Cost Institute
    Sep 24, 2012 … MS-DRG (v26.0) Mapping to Inpatient Service Category . … Major Diagnostic
    Category (MDC) to MS-DRG Mapping . …… P. 811-27.

    http://www.healthcostinstitute.org/files/Vermont%20Methodology%205-13-2014.pdf
    Download the Methodology (PDF) – Health Care Cost Institute
    May 13, 2014 … categories based on the MS-DRG code—medical, surgical, ….. P. 811-. 27. The
    specific methodology is proprietary and not owned by HCCI.

    http://www.healthcostinstitute.org/files/HCCI%202012%20Methodology.pdf
    HCCUR Analytic Methodology – Health Care Cost Institute
    4.1 Inpatient facility detailed service categories and corresponding MS-DRG
    codes …… 811-27. The specific methodology is proprietary and not owned by
    HCCI.

    http://www.patientcareanalyst.com/documentation/codes/CMSv24_MSv25map.pdf
    Medicare Severity DRGs – Patient Care Analyst
    MS-DRG Descriptions … assigned to MS-DRG 005 regardless of severity level
    …… 811. Red blood cell disorders w MCC. 396. 812. Red blood cell disorders w/o
     …

    http://health.state.tn.us/statistics/PdfFiles/y08d120.pdf
    drg 120 – the Tennessee Department of Health
    Number of Cases and Median Charges ($) Based on APR-DRGs* … *APR-DRGs
    : All Patient Refined Diagnosis Related Groups adjusting for severity of illness ….
    811 . . 8 116. Sullivan. 8220 Wellmont Bristol Regional Med. Ctr. . . 7. 41,788.

    http://www.health.ny.gov/statistics/sparcs/sysdoc/inpatientoutputdd.pdf
    SPARCS Inpatient Output Data Dictionary – New York State …
    Jul 1, 2011 … DRGs. Due to the large number of data elements and the repetitive nature of
    some of the data elements,. SPARCS cannot put all ….. 811 – 812.

    http://healthdata.brhpc.org/Docs/DRG_Medical_Services_Guide.pdf
    MEDICAL SERVICES DRGDATA WAREHOUSE – Florida Health …
    Medical Services/DRGs (this is used for all custom reports). The following are ….
    The MS/DRG Data Warehouse uses a modified version of the Medicare Major
    Diagnostic Groups. (MDC) to ….. 811 Red blood cell disorders w MCC. Oncology.

    http://www.rand.org/content/dam/rand/pubs/monograph_reports/2006/MR304.pdf
    An Evaluation of Medicare Payments for Transfer Cases
    _ . . . . . . . . 12. CostS Within DRGS wi出 Many Transfer CaseS . . , . …
    RegreSSion Model Covering Transfers in AH DRGs . . . . . . . . . . . . . . . 18 … F1 811
    reS. 3.1.

    http://www.jneurosci.org/content/24/8/1941.full.pdf
    Essential Function of Oncostatin M in Nociceptive – The Journal of …
    situ hybridization revealed that OSMR-positive neurons in DRGs began to
    appear at … biology, Wakayama Medical University, 811-1 Kimiidera, Wakayama,
     …

    http://www.tmhp.com/News_Items/2010/08-13-10%20Present%20on%20Admission%20Reporting.pdf
    Present on Admission Reporting Required on Hospital … – TMHP.com
    Aug 13, 2010 … (Based on 50th percentile for fiscal year [FY] 2008). Principal Diagnosis. • MS-
    DRG 066. • Intercranial hemmorage or cerebral infarction (stroke).

    https://www.colorado.gov/pacific/sites/default/files/Rule_18_prior_to_2014.pdf
    DEPARTMENT OF LABOR AND EMPLOYMENT … – Colorado.gov
    and MS-DRGs, unless otherwise specified in this Rule. This Rule … may be
    purchased from the AMA, the MS-DRGs Definitions Manual may be purchased
    from 3M …… (3) For organ acquisition allowance, (revenue codes 811-812) see
    18-.

    http://www.hcca-info.org/Portals/0/PDFs/Resources/Conference_Handouts/Compliance_Institute/2012/P3print2.pdf
    What to Do When A Recovery Auditor Knocks on Your Hospital's Door
    with CC, and MS-DRG 639, diabetes without a CC or MCC. *Will be readjusted
    based …… 315 316 393 551 552 640 682 683 684 689 811. 73. Copyright ©2012
     …

    http://dev.biologists.org/content/119/1/49.full.pdf
    Stem cell factor induces outgrowth of c-kit-positive … – Development
    shown that dorsal root ganglia (DRGs) of mice express c- kit mRNA … Keshet et
    al., 1991), we cultured DRGs from normal (+/+) …… Nature 352, 809-811. Eldik …

    http://hfmaky.org/downloads/modeling_reimbursement_methodologies_in_the_changing_payment_environment___david_hammer.pdf
    Modeling Reimbursement in the Changing Payment Environment
    Jul 24, 2014 … 278 Providers, 175 IDNs, 463 Facilities, 48 Episodes, 178 DRGs ….. 811, 812.
    Red Blood Cell Disorders. 787. $4,837,423. $5,685,447.

    code aded to inpatient only list for calendar year 2015 opps

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    By , July 15, 2015 3:51 am
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  • code aded to inpatient only list for calendar year 2015 opps

    http://www.abbottvascular.com/docs/reimbursement/OPPS_Guide_2015.pdf
    OPPS – Abbott Vascular
    Jan 1, 2015 … Update for Calendar Year (CY) 2015.1 The information in this document is
    effective … New CPT Codes Added to OPPS Inpatient Only List.

    http://www.aha.org/advocacy-issues/letter/2014/140827-cl-cms1613p.pdf
    August 27, 2014 Marilyn B. Tavenner Administrator Centers for …
    Aug 27, 2014 … (CMS) proposed rule for the calendar year (CY) 2015 hospital outpatient and
    ambulatory … to the inpatient-only list; changes to the proton beam radiation
    therapy …. Revising the add-on code packaging policy established in CY 2014 by
    packaging all add- … As noted in our comments on the CY 2014 OPPS.

    http://information.medassets.com/rs/medassets/images/CCFN-2015-January.pdf
    January 2015 Hospital Outpatient Prospective Payment … – MedAssets
    Jan 1, 2015 … From new HCPCS codes to replacement CPT® codes … discontinued
    procedures, you'll have a complete inventory of OPPS … for 2015. Beyond just
    listing all the changes, Guilbeau provides you with …. For calendar year (CY)
    2015, CMS will terminate two ….. added the element of “time” to its definition and.

    http://www.cordis.com/sites/default/files/pdfs/HE-R/23197%20-%20FINAL_2014%20Cardiac%20and%20Vascular%20Guide.pdf
    2014 Cordis® Cardiac & Vascular Procedures Reimbursement Guide
    Aug 2, 2013 … information purposes only and represents no statement, promise or guarantee ….
    Beginning with fiscal year 2015, hospitals that do not participate will lose one-
    quarter of the …. codes used in the inpatient setting to report percutaneous ….. A
    total of twenty-three SIs are listed in the calendar year 2014 OPPS …

    http://www.bostonscientific.com/content/dam/bostonscientific/Reimbursement/IC/Final_OPPS_CRV-278904-AA_NOV2014.pdf/
    CY2015 Medicare Final Rules for OPPS, ASC … – Boston Scientific
    (See Table 1 for a list of interventional cardiology combination codes). It should
    also be noted that this payment is $2,766 greater than the national average for
    inpatient MS-DRG 247 Percutaneous … The resulting year-over-year hospital
    payment increase is ~ $5,788 or 23% … ICD PG only payment rates decrease by
    11.3%.

    http://www.cgsmedicare.com/hhh/pubs/mb_hhh/2015/j15_hhh_02-15.pdf
    Medicare Bulletin – February 2015 – CGS Medicare
    Feb 2, 2015 … Descriptions and other data only are copyrighted 2009 American Medical …
    Payment System (OPPS) … MM9034: Summary of Policies in the Calendar. Year
    (CY) 2015 Medicare Physician Fee ….. Table 5: CY 2015 LUPA Add-On factors
    ….. provided under Section 1834(k)(5) of the Act, a therapy code list …

    http://www.accc-cancer.org/oncology_issues/articles/JF15/JF15-COMPLIANCE-Published-before-Print-12-11-14.pdf
    Oncology Reimbursement Update 2015 – Association of Community …
    Guidelines: “military history” has been added as one of the items … in calendar
    year (CY) 2015, but it will consider separate … File for 2015 lists the code as
    S0832.) … are now only three codes for treatment delivery at …. OPPS will be
    approximately $56.1 billion in CY. 2015, an …. inpatient hospital services under
    the name,…

    http://www.dhs.state.mn.us/main/groups/publications/documents/pub/dhs16_189135.pdf
    Changes to DHS BRASS Manual for Calendar Year 2015
    Jan 1, 2015 … The changes in this bulletin list the current BRASS codes and their … has been
    changed or added for six (6) BRASS codes for 2015. …. 473x Acute Care
    Hospital Inpatient ….. Specialized supplies and equipment (CAC, CADI, BI only)
    … Opportunities for personal growth and development which enable …

    http://www.chausa.org/docs/default-source/advocacy/071414-summary-of-proposed-fy2015-opps-rule.pdf?sfvrsn=2
    proposed rule – Catholic Health Association of the United States
    Jul 14, 2014 … 1 Henceforth in this document, a year is a calendar year unless … Proposed
    Procedures That Would Be Paid Only as Inpatient Procedures… … C. Proposed
    update to the Lists of ASC Covered Surgical Procedures and …. OPPS, including
    codes that would be affected by the proposed 2015 OPPS expanded.

    http://www.cahabagba.com/documents/2015/01/february-2015-medicare-newsline.pdf
    February 2015 – Cahaba GBA
    Feb 2, 2015 … Fiscal Year (FY) 2015 Inpatient Prospective Payment … Rate Update for
    Calendar Year (CY) 2015. … Prospective Payment System (OPPS)… …. add us to
    your contact lists, adjust your spam settings, or follow the ….. Note that Medicare
    pays claims with code G0473 only when submitted by the following.

    http://www.nimitt.com/_images/_PRTdocs/PRT_CY_2015_OPPS_Proposed-Rule_Comments.pdf
    PRT OPPS Comments
    Apr 5, 2014 … for one year in order to work on a complexity adjustment; we request CMS to
    delay the …. assigned to a device-dependent APC for CY 2015. … Add-on Codes
    have been packaged services since January 2014 and we acknowledge that …..
    OPPS and has remained off the Inpatient-only List since then.

    https://www.acponline.org/advocacy/where_we_stand/assets/summary_of_cy2015__proposed_rule_physician_fee_schedule.pdf
    Summary of the Proposed Medicare Physician Fee Schedule Rule …
    In prior years CMS has expressed concerns about the accuracy of the information
    they use … idea was to use the Outpatient Prospective Payment System (OPPS)
    and ….. hour (list separately in addition to code for office or other outpatient
    evaluation ….. on 2015 reporting data) and each subsequent calendar year
    payment.

    http://www.hca.wa.gov/medicaid/billing/documents/guides/outpatient_hospital.pdf
    Download – Health Care Authority
    Apr 1, 2015 … This publication takes effect April 1, 2015, and supersedes earlier … Inpatient
    Hospital Services … What is the outpatient prospective payment system (OPPS)
    payment … about outpatient hospital services provided within one calendar day
    of ….. code S2900 and reimburses only for the underlying procedure.

    https://www.facs.org/ahp/cy-2013-opps-asc-comment-letter.pdf
    CY 2013 ACS OPPS/ASC Comment Letter – American College of …
    Aug 31, 2012 … calendar year (CY) 2013 proposed rule: Hospital Outpatient Prospective and.
    Ambulatory … that involve not only angioplasty, but also stent placement.
    Moreover … We urge CMS to add the codes below to the inpatient list because
    they should only be ….. 2014 OQR Measure; ASC-7: 2015 ASCQR Measure).

    http://www.plasticsurgery.org/Documents/Health-Policy/Coding-Payment/hopps-proposed-rule-2015.pdf
    CY 2015 HOPPS Proposed Rule – American Society of Plastic …
    Jul 1, 2014 … prospective payment system (OPPS) and the Medicare ambulatory surgical
    center … for hospital inpatient admissions only for long-stay cases and outlier
    cases; and changes …. Calendar year …. Described by Add-On Codes …. Policies
    Governing Changes to the Lists of Codes and Payment Rates for ASC.

    https://www.noridianmedicare.com/je/partb/bulletins/medicare_b_news_september_2014.pdf
    Medicare B News – Noridian Home
    Sep 2, 2014 … CMS Proposes OPPS And ASC Quality Changes For 2015 . … Category III CPT
    Codes Supplemental Instructions Retirement – ….. are added throughout the
    quarter, (electronic mailing list) at …. Under this proposal, valid only for the 2014
    reporting year, providers ….. elements, for all inpatient admissions.

    http://rcbp.coventryhealthcare.com/web/groups/public/@cvty_mailhandlers_mhbp/documents/webcontent/a052694.pdf
    Health Benefits Resource Guide 2015 – MHBP
    This brochure is provided for descriptive purposes only. Please refer …
    precertification of inpatient admissions and may … A formulary is a list of
    prescription drugs … typically apply on a per-calendar-year basis and can …
    Expand your coverage when you add one … Affordable monthly rates — based
    on your home ZIP code:.

    http://www.medpac.gov/documents/comment-letters/medpac-comment-on-cms-s-proposed-rule-for-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment-systems-and-quality-reporting-programs.pdf?sfvrsn=0
    MedPAC comment on CMS's proposed rule on hospital outpatient …
    Aug 26, 2014 … As you know, the outpatient prospective payment system (OPPS) … also
    estimates the calendar year 2015 update to the conversion factors … CMS has
    proposed that the only costs on a claim with a HCPCS code that maps to a C-
    APC that … In this rule, CMS has proposed to add two categories to the list of …

    http://www.empireblue.com/provider/noapplication/f5/s1/t2/pw_e230182.pdf?refer=ehpprovider
    February 2015 – Empire Blue Cross Blue Shield
    Feb 1, 2015 … Expanded List of Outpatient Procedures for … Long Term Acute Care and
    Inpatient Rehab … Pathway regimens for other malignancies may be added in
    2015. ….. You would need to bill the appropriate delivery only code (either 59409,
    …. services please bill the dates of services using calendar year format.

    http://www.qualityreportingcenter.com/wp-content/uploads/2015/01/OQR_012115-SpecificationsManual_3s.pdf
    OQR Webinar 012115 – Quality Reporting Center
    Jan 9, 2015 … The list of hospitals selected for calendar year. (CY) 2016 … February 1, 2015, is
    the next deadline for Clinical … Updated Postal Code. 9. 1/21/2015 … Added OP-
    32 Facility 7-Day Risk-Standardized … only be nine months; the table has not
    been adjusted …. “Finalized in the CY 2015 OPPS/ASC final rule,.

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