The Centers for Medicare and Medicaid Services (CMS) requires all hospitals to post a list of their standard charges — a Charge Description Master (CDM) — on the internet in machine-readable format and update that data at least annually. CMS intends for this information to help patients with improved information regarding price transparency.
However, please note that a patient’s out-of-pocket cost is not determined by the standard charges of a hospital. The out-of-pocket cost is driven primarily by:
- The contracted rate that the patient’s insurance carrier will pay the hospital, which is generally less than the standard charges; and
- Any copay, deductible or coinsurance required by the patient’s benefit plan.
Estimating Out-of-Pocket Costs
Many patients who seek hospital charge information are interested in knowing their potential out-of-pocket financial responsibility. The new CMS requirement provides an opportunity to have important conversations regarding finances.
Those with health insurance can be directed to contact their health plan for specific financial obligations.
- Those without health insurance will be provided information related to the hospital's financial assistance policy and any discounts that can be applied.
If you have questions regarding your out-of-pocket cost for a specific service, contact our Financial Estimators at firstname.lastname@example.org. They can review your personal situation to give you the most accurate estimate and connect you with a financial counselor if you need financial assistance.
Charge Description Master
What the Prices Include
Hospital prices are the same for all patients, however actual billed amounts for a patient's visit may vary due to the combination of services provided to the individual patient at that particular visit. Please also note that out-of-pocket costs may vary depending on payment plans agreed to by your health insurers.
Our billed charges are based on the hospital's costs to provide services, which may include:
- 24-hour services such as emergency room and laboratory testing
- Medical supplies
- Pharmaceuticals and drugs
- Medical equipment and technology upgrades
- Hospital buildings (facility)
- Patient dietary and laundry services
- Patient support services, including financial counseling and social services
In addition, our charges include the hospital's costs related to our financial commitments, our mission to serve the community and our overall mix of health services.
Inpatient charges are normally higher than outpatient charges, because procedures that are performed on an outpatient basis are generally less complex than those that require an inpatient stay. For example, patients with potential risk factors generally have the procedure performed as an inpatient rather than outpatient. As expected, the inpatient setting includes additional costs and the patients in this setting generally require more services.
Costs of Pharmacy/Drugs
The cost of obtaining drugs/pharmaceuticals changes often due to the ongoing changes in the prices of drugs. For example, new drugs are approved by the FDA, or brand-name drugs become available as generics.The hospital's pharmacy drug prices are tied to a published quarterly Average Wholesale Price (AWP) listing.
Viewing the CDM
If you wish to review the CDM, please understand the following:
- The descriptions in the CDM may not be understandable to the layperson (people who are not health care professionals).
- The total charge amount for many procedures is made up of many individually charged items from the CDM.
The CDM information is not intended to replace professional medical advice, diagnosis or treatment.