Price Transparency - South Davis Community Hospital

WP Price Transparency

Charge	Hospital Revenue Code	code\|1\|type	Type (Location)	Type (Charge)	Price	Self-Pay Discount	payer_name	plan_name	Standard Negotiated	standard_charge\|negotiated_algorithm	standard_charge\|min	standard_charge\|max	standard_charge\|methodology
MS-LTC-DRG 100: Seizures with MCC	100	MS-DRG	facility	inpatient			Aetna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 100: Seizures with MCC	100	MS-DRG	facility	inpatient			American Health Plans	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 100: Seizures with MCC	100	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 100: Seizures with MCC	100	MS-DRG	facility	inpatient			Cigna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 100: Seizures with MCC	100	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 100: Seizures with MCC	100	MS-DRG	facility	inpatient			Humana of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 100: Seizures with MCC	100	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 100: Seizures with MCC	100	MS-DRG	facility	inpatient			Pacific Source	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 100: Seizures with MCC	100	MS-DRG	facility	inpatient			Select Health	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 100: Seizures with MCC	100	MS-DRG	facility	inpatient			Tricare West	Military	41788.22	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 101: Seizures without MCC	101	MS-DRG	facility	inpatient			Aetna of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 101: Seizures without MCC	101	MS-DRG	facility	inpatient			American Health Plans	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 101: Seizures without MCC	101	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 101: Seizures without MCC	101	MS-DRG	facility	inpatient			Cigna of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 101: Seizures without MCC	101	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 101: Seizures without MCC	101	MS-DRG	facility	inpatient			Humana of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 101: Seizures without MCC	101	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 101: Seizures without MCC	101	MS-DRG	facility	inpatient			Pacific Source	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 101: Seizures without MCC	101	MS-DRG	facility	inpatient			Select Health	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 101: Seizures without MCC	101	MS-DRG	facility	inpatient			Tricare West	Military	24374.12	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 102: Headaches with MCC	102	MS-DRG	facility	inpatient			Aetna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 102: Headaches with MCC	102	MS-DRG	facility	inpatient			American Health Plans	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 102: Headaches with MCC	102	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 102: Headaches with MCC	102	MS-DRG	facility	inpatient			Cigna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 102: Headaches with MCC	102	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 102: Headaches with MCC	102	MS-DRG	facility	inpatient			Humana of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 102: Headaches with MCC	102	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 102: Headaches with MCC	102	MS-DRG	facility	inpatient			Pacific Source	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 102: Headaches with MCC	102	MS-DRG	facility	inpatient			Select Health	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 102: Headaches with MCC	102	MS-DRG	facility	inpatient			Tricare West	Military	41788.22	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 103: Headaches without MCC	103	MS-DRG	facility	inpatient			Aetna of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 103: Headaches without MCC	103	MS-DRG	facility	inpatient			American Health Plans	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 103: Headaches without MCC	103	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 103: Headaches without MCC	103	MS-DRG	facility	inpatient			Cigna of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 103: Headaches without MCC	103	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 103: Headaches without MCC	103	MS-DRG	facility	inpatient			Humana of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 103: Headaches without MCC	103	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 103: Headaches without MCC	103	MS-DRG	facility	inpatient			Pacific Source	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 103: Headaches without MCC	103	MS-DRG	facility	inpatient			Select Health	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 103: Headaches without MCC	103	MS-DRG	facility	inpatient			Tricare West	Military	24374.12	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
Room & Board Private Peds	110	RC	facility	inpatient	3200	1600	AARP	Medicare	1430		1.200,00	2.560,00	per diem
Room & Board Private WP	110	RC	facility	inpatient	3200	1600	AARP	Medicare	1430		1.200,00	2.560,00	per diem
Room & Board Private Peds	110	RC	facility	inpatient	3200	1600	Deseret Mutual Benefit Administrators	HMO	1400		1.200,00	2.560,00	per diem
Room & Board Private WP	110	RC	facility	inpatient	3200	1600	Deseret Mutual Benefit Administrators	HMO	1400		1.200,00	2.560,00	per diem
Room & Board Private Peds	110	RC	facility	inpatient	3200	1600	HealthChoice UT	Commercial	2400		1.200,00	2.560,00	percent of total billed charges
Room & Board Private WP	110	RC	facility	inpatient	3200	1600	HealthChoice UT	Commercial	2400		1.200,00	2.560,00	percent of total billed charges
Room & Board Private Peds	110	RC	facility	inpatient	3200	1600	Presbyterian Health Plan	Commercial/Medicaid/Medicare	1420		1.200,00	2.560,00	per diem
Room & Board Private WP	110	RC	facility	inpatient	3200	1600	Presbyterian Health Plan	Commercial/Medicaid/Medicare	1420		1.200,00	2.560,00	per diem
Room & Board Private Peds	110	RC	facility	inpatient	3200	1600	Provider Network of America	Commercial	2560		1.200,00	2.560,00	percent of total billed charges
Room & Board Private WP	110	RC	facility	inpatient	3200	1600	Provider Network of America	Commercial	2560		1.200,00	2.560,00	percent of total billed charges
Room & Board Private Peds	110	RC	facility	inpatient	3200	1600	Select Health	Commercial	1200		1.200,00	2.560,00	per diem
Room & Board Private WP	110	RC	facility	inpatient	3200	1600	Select Health	Commercial	1200		1.200,00	2.560,00	per diem
Room & Board Private Peds	110	RC	facility	inpatient	3200	1600	University of Utah Health Plans	Healthy Advantage Medicare/Healthy Preferred/Healthy Premier/Medicaid	1200		1.200,00	2.560,00	per diem
Room & Board Private WP	110	RC	facility	inpatient	3200	1600	University of Utah Health Plans	Healthy Advantage Medicare/Healthy Preferred/Healthy Premier/Medicaid	1200		1.200,00	2.560,00	per diem
Room & Board Private Peds	110	RC	facility	inpatient	3200	1600	UUHP Mountain Health CO-OP	Marketplace	1200		1.200,00	2.560,00	per diem
Room & Board Private WP	110	RC	facility	inpatient	3200	1600	UUHP Mountain Health CO-OP	Marketplace	1200		1.200,00	2.560,00	per diem
MS-LTC-DRG 113: Orbital procedures with CC/MCC	113	MS-DRG	facility	inpatient			Aetna of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 113: Orbital procedures with CC/MCC	113	MS-DRG	facility	inpatient			American Health Plans	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 113: Orbital procedures with CC/MCC	113	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 113: Orbital procedures with CC/MCC	113	MS-DRG	facility	inpatient			Cigna of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 113: Orbital procedures with CC/MCC	113	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 113: Orbital procedures with CC/MCC	113	MS-DRG	facility	inpatient			Humana of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 113: Orbital procedures with CC/MCC	113	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 113: Orbital procedures with CC/MCC	113	MS-DRG	facility	inpatient			Pacific Source	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 113: Orbital procedures with CC/MCC	113	MS-DRG	facility	inpatient			Select Health	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 113: Orbital procedures with CC/MCC	113	MS-DRG	facility	inpatient			Tricare West	Military	60834.78	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 114: Orbital procedures without CC/MCC	114	MS-DRG	facility	inpatient			Aetna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 114: Orbital procedures without CC/MCC	114	MS-DRG	facility	inpatient			American Health Plans	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 114: Orbital procedures without CC/MCC	114	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 114: Orbital procedures without CC/MCC	114	MS-DRG	facility	inpatient			Cigna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 114: Orbital procedures without CC/MCC	114	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 114: Orbital procedures without CC/MCC	114	MS-DRG	facility	inpatient			Humana of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 114: Orbital procedures without CC/MCC	114	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 114: Orbital procedures without CC/MCC	114	MS-DRG	facility	inpatient			Pacific Source	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 114: Orbital procedures without CC/MCC	114	MS-DRG	facility	inpatient			Select Health	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 114: Orbital procedures without CC/MCC	114	MS-DRG	facility	inpatient			Tricare West	Military	41788.22	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 115: Extraocular procedures except orbit	115	MS-DRG	facility	inpatient			Aetna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 115: Extraocular procedures except orbit	115	MS-DRG	facility	inpatient			American Health Plans	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 115: Extraocular procedures except orbit	115	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 115: Extraocular procedures except orbit	115	MS-DRG	facility	inpatient			Cigna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 115: Extraocular procedures except orbit	115	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 115: Extraocular procedures except orbit	115	MS-DRG	facility	inpatient			Humana of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 115: Extraocular procedures except orbit	115	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 115: Extraocular procedures except orbit	115	MS-DRG	facility	inpatient			Pacific Source	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 115: Extraocular procedures except orbit	115	MS-DRG	facility	inpatient			Select Health	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 115: Extraocular procedures except orbit	115	MS-DRG	facility	inpatient			Tricare West	Military	41788.22	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 116: Intraocular procedures with CC/MCC	116	MS-DRG	facility	inpatient			Aetna of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 116: Intraocular procedures with CC/MCC	116	MS-DRG	facility	inpatient			American Health Plans	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 116: Intraocular procedures with CC/MCC	116	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 116: Intraocular procedures with CC/MCC	116	MS-DRG	facility	inpatient			Cigna of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 116: Intraocular procedures with CC/MCC	116	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 116: Intraocular procedures with CC/MCC	116	MS-DRG	facility	inpatient			Humana of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 116: Intraocular procedures with CC/MCC	116	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 116: Intraocular procedures with CC/MCC	116	MS-DRG	facility	inpatient			Pacific Source	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 116: Intraocular procedures with CC/MCC	116	MS-DRG	facility	inpatient			Select Health	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 116: Intraocular procedures with CC/MCC	116	MS-DRG	facility	inpatient			Tricare West	Military	60834.78	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 117: Intraocular procedures without CC/MCC	117	MS-DRG	facility	inpatient			Aetna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 117: Intraocular procedures without CC/MCC	117	MS-DRG	facility	inpatient			American Health Plans	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 117: Intraocular procedures without CC/MCC	117	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 117: Intraocular procedures without CC/MCC	117	MS-DRG	facility	inpatient			Cigna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 117: Intraocular procedures without CC/MCC	117	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 117: Intraocular procedures without CC/MCC	117	MS-DRG	facility	inpatient			Humana of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 117: Intraocular procedures without CC/MCC	117	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 117: Intraocular procedures without CC/MCC	117	MS-DRG	facility	inpatient			Pacific Source	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 117: Intraocular procedures without CC/MCC	117	MS-DRG	facility	inpatient			Select Health	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 117: Intraocular procedures without CC/MCC	117	MS-DRG	facility	inpatient			Tricare West	Military	41788.22	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
Room & Board 118	118	RC	facility	inpatient	3200	1600	HealthChoice UT	Commercial	2400		2.400,00	2.560,00	percent of total billed charges
Room & Board 118	118	RC	facility	inpatient	3200	1600	Provider Network of America	Commercial	2560		2.400,00	2.560,00	percent of total billed charges
Room & Board Semi-Private Peds	120	RC	facility	inpatient	3200	1600	AARP	Medicare	1430		800,00	2.560,00	per diem
Room & Board Semi-Private Peds	120	RC	facility	inpatient	3200	1600	Aetna of UT	HMO	850		800,00	2.560,00	per diem
Room & Board Semi-Private Peds	120	RC	facility	inpatient	3200	1600	Blue Cross of UT	Federal/HMO	1400		800,00	2.560,00	per diem
Room & Board Semi-Private Peds	120	RC	facility	inpatient	3200	1600	Cigna of UT	HMO	1250		800,00	2.560,00	per diem
Room & Board Semi-Private Peds	120	RC	facility	inpatient	3200	1600	HealthChoice UT	Commercial	2400		800,00	2.560,00	percent of total billed charges
Room & Board Semi-Private Peds	120	RC	facility	inpatient	3200	1600	Molina of UT	Medicaid	1293.95		800,00	2.560,00	per diem
Room & Board Semi-Private Peds	120	RC	facility	inpatient	3200	1600	Pacific Source	Commercial	800		800,00	2.560,00	per diem
Room & Board Semi-Private Peds	120	RC	facility	inpatient	3200	1600	Presbyterian Health Plan	Commercial/Medicaid/Medicare	1650		800,00	2.560,00	per diem
Room & Board Semi-Private Peds	120	RC	facility	inpatient	3200	1600	Provider Network of America	Commercial	2560		800,00	2.560,00	percent of total billed charges
Room & Board Semi-Private Peds	120	RC	facility	inpatient	3200	1600	Public Employee Health Plan	Commercial	1200		800,00	2.560,00	per diem
MS-LTC-DRG 121: Acute major eye infections with CC/MCC	121	MS-DRG	facility	inpatient			Aetna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 121: Acute major eye infections with CC/MCC	121	MS-DRG	facility	inpatient			American Health Plans	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 121: Acute major eye infections with CC/MCC	121	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 121: Acute major eye infections with CC/MCC	121	MS-DRG	facility	inpatient			Cigna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 121: Acute major eye infections with CC/MCC	121	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 121: Acute major eye infections with CC/MCC	121	MS-DRG	facility	inpatient			Humana of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 121: Acute major eye infections with CC/MCC	121	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 121: Acute major eye infections with CC/MCC	121	MS-DRG	facility	inpatient			Pacific Source	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 121: Acute major eye infections with CC/MCC	121	MS-DRG	facility	inpatient			Select Health	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 121: Acute major eye infections with CC/MCC	121	MS-DRG	facility	inpatient			Tricare West	Military	18346.93	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 122: Acute major eye infections without CC/MCC	122	MS-DRG	facility	inpatient			Aetna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 122: Acute major eye infections without CC/MCC	122	MS-DRG	facility	inpatient			American Health Plans	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 122: Acute major eye infections without CC/MCC	122	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 122: Acute major eye infections without CC/MCC	122	MS-DRG	facility	inpatient			Cigna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 122: Acute major eye infections without CC/MCC	122	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 122: Acute major eye infections without CC/MCC	122	MS-DRG	facility	inpatient			Humana of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 122: Acute major eye infections without CC/MCC	122	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 122: Acute major eye infections without CC/MCC	122	MS-DRG	facility	inpatient			Pacific Source	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 122: Acute major eye infections without CC/MCC	122	MS-DRG	facility	inpatient			Select Health	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 122: Acute major eye infections without CC/MCC	122	MS-DRG	facility	inpatient			Tricare West	Military	18346.93	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 123: Neurological eye disorders	123	MS-DRG	facility	inpatient			Aetna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 123: Neurological eye disorders	123	MS-DRG	facility	inpatient			American Health Plans	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 123: Neurological eye disorders	123	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 123: Neurological eye disorders	123	MS-DRG	facility	inpatient			Cigna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 123: Neurological eye disorders	123	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 123: Neurological eye disorders	123	MS-DRG	facility	inpatient			Humana of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 123: Neurological eye disorders	123	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 123: Neurological eye disorders	123	MS-DRG	facility	inpatient			Pacific Source	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 123: Neurological eye disorders	123	MS-DRG	facility	inpatient			Select Health	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 123: Neurological eye disorders	123	MS-DRG	facility	inpatient			Tricare West	Military	18346.93	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 124: Other disorders of the eye with MCC or thrombolytic agent	124	MS-DRG	facility	inpatient			Aetna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 124: Other disorders of the eye with MCC or thrombolytic agent	124	MS-DRG	facility	inpatient			American Health Plans	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 124: Other disorders of the eye with MCC or thrombolytic agent	124	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 124: Other disorders of the eye with MCC or thrombolytic agent	124	MS-DRG	facility	inpatient			Cigna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 124: Other disorders of the eye with MCC or thrombolytic agent	124	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 124: Other disorders of the eye with MCC or thrombolytic agent	124	MS-DRG	facility	inpatient			Humana of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 124: Other disorders of the eye with MCC or thrombolytic agent	124	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 124: Other disorders of the eye with MCC or thrombolytic agent	124	MS-DRG	facility	inpatient			Pacific Source	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 124: Other disorders of the eye with MCC or thrombolytic agent	124	MS-DRG	facility	inpatient			Select Health	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 124: Other disorders of the eye with MCC or thrombolytic agent	124	MS-DRG	facility	inpatient			Tricare West	Military	18346.93	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 125: Other disorders of the eye without MCC	125	MS-DRG	facility	inpatient			Aetna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 125: Other disorders of the eye without MCC	125	MS-DRG	facility	inpatient			American Health Plans	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 125: Other disorders of the eye without MCC	125	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 125: Other disorders of the eye without MCC	125	MS-DRG	facility	inpatient			Cigna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 125: Other disorders of the eye without MCC	125	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 125: Other disorders of the eye without MCC	125	MS-DRG	facility	inpatient			Humana of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 125: Other disorders of the eye without MCC	125	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 125: Other disorders of the eye without MCC	125	MS-DRG	facility	inpatient			Pacific Source	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 125: Other disorders of the eye without MCC	125	MS-DRG	facility	inpatient			Select Health	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 125: Other disorders of the eye without MCC	125	MS-DRG	facility	inpatient			Tricare West	Military	18346.93	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 135: Sinus and mastoid procedures with CC/MCC	135	MS-DRG	facility	inpatient			Aetna of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 135: Sinus and mastoid procedures with CC/MCC	135	MS-DRG	facility	inpatient			American Health Plans	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 135: Sinus and mastoid procedures with CC/MCC	135	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 135: Sinus and mastoid procedures with CC/MCC	135	MS-DRG	facility	inpatient			Cigna of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 135: Sinus and mastoid procedures with CC/MCC	135	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 135: Sinus and mastoid procedures with CC/MCC	135	MS-DRG	facility	inpatient			Humana of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 135: Sinus and mastoid procedures with CC/MCC	135	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 135: Sinus and mastoid procedures with CC/MCC	135	MS-DRG	facility	inpatient			Pacific Source	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 135: Sinus and mastoid procedures with CC/MCC	135	MS-DRG	facility	inpatient			Select Health	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 135: Sinus and mastoid procedures with CC/MCC	135	MS-DRG	facility	inpatient			Tricare West	Military	60834.78	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 136: Sinus and mastoid procedures without CC/MCC	136	MS-DRG	facility	inpatient			Aetna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 136: Sinus and mastoid procedures without CC/MCC	136	MS-DRG	facility	inpatient			American Health Plans	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 136: Sinus and mastoid procedures without CC/MCC	136	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 136: Sinus and mastoid procedures without CC/MCC	136	MS-DRG	facility	inpatient			Cigna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 136: Sinus and mastoid procedures without CC/MCC	136	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 136: Sinus and mastoid procedures without CC/MCC	136	MS-DRG	facility	inpatient			Humana of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 136: Sinus and mastoid procedures without CC/MCC	136	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 136: Sinus and mastoid procedures without CC/MCC	136	MS-DRG	facility	inpatient			Pacific Source	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 136: Sinus and mastoid procedures without CC/MCC	136	MS-DRG	facility	inpatient			Select Health	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 136: Sinus and mastoid procedures without CC/MCC	136	MS-DRG	facility	inpatient			Tricare West	Military	41788.22	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 137: Mouth procedures with CC/MCC	137	MS-DRG	facility	inpatient			Aetna of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 137: Mouth procedures with CC/MCC	137	MS-DRG	facility	inpatient			American Health Plans	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 137: Mouth procedures with CC/MCC	137	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 137: Mouth procedures with CC/MCC	137	MS-DRG	facility	inpatient			Cigna of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 137: Mouth procedures with CC/MCC	137	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 137: Mouth procedures with CC/MCC	137	MS-DRG	facility	inpatient			Humana of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 137: Mouth procedures with CC/MCC	137	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 137: Mouth procedures with CC/MCC	137	MS-DRG	facility	inpatient			Pacific Source	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 137: Mouth procedures with CC/MCC	137	MS-DRG	facility	inpatient			Select Health	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 137: Mouth procedures with CC/MCC	137	MS-DRG	facility	inpatient			Tricare West	Military	60834.78	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 138: Mouth procedures without CC/MCC	138	MS-DRG	facility	inpatient			Aetna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 138: Mouth procedures without CC/MCC	138	MS-DRG	facility	inpatient			American Health Plans	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 138: Mouth procedures without CC/MCC	138	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 138: Mouth procedures without CC/MCC	138	MS-DRG	facility	inpatient			Cigna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 138: Mouth procedures without CC/MCC	138	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 138: Mouth procedures without CC/MCC	138	MS-DRG	facility	inpatient			Humana of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 138: Mouth procedures without CC/MCC	138	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 138: Mouth procedures without CC/MCC	138	MS-DRG	facility	inpatient			Pacific Source	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 138: Mouth procedures without CC/MCC	138	MS-DRG	facility	inpatient			Select Health	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 138: Mouth procedures without CC/MCC	138	MS-DRG	facility	inpatient			Tricare West	Military	41788.22	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 139: Salivary gland procedures	139	MS-DRG	facility	inpatient			Aetna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 139: Salivary gland procedures	139	MS-DRG	facility	inpatient			American Health Plans	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 139: Salivary gland procedures	139	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 139: Salivary gland procedures	139	MS-DRG	facility	inpatient			Cigna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 139: Salivary gland procedures	139	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 139: Salivary gland procedures	139	MS-DRG	facility	inpatient			Humana of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 139: Salivary gland procedures	139	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 139: Salivary gland procedures	139	MS-DRG	facility	inpatient			Pacific Source	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 139: Salivary gland procedures	139	MS-DRG	facility	inpatient			Select Health	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 139: Salivary gland procedures	139	MS-DRG	facility	inpatient			Tricare West	Military	41788.22	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 140: Major head and neck procedures with MCC	140	MS-DRG	facility	inpatient			Aetna of UT	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 140: Major head and neck procedures with MCC	140	MS-DRG	facility	inpatient			American Health Plans	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 140: Major head and neck procedures with MCC	140	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 140: Major head and neck procedures with MCC	140	MS-DRG	facility	inpatient			Cigna of UT	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 140: Major head and neck procedures with MCC	140	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 140: Major head and neck procedures with MCC	140	MS-DRG	facility	inpatient			Humana of UT	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 140: Major head and neck procedures with MCC	140	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 140: Major head and neck procedures with MCC	140	MS-DRG	facility	inpatient			Pacific Source	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 140: Major head and neck procedures with MCC	140	MS-DRG	facility	inpatient			Select Health	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 140: Major head and neck procedures with MCC	140	MS-DRG	facility	inpatient			Tricare West	Military	93278.66	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 141: Major head and neck procedures with CC	141	MS-DRG	facility	inpatient			Aetna of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 141: Major head and neck procedures with CC	141	MS-DRG	facility	inpatient			American Health Plans	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 141: Major head and neck procedures with CC	141	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 141: Major head and neck procedures with CC	141	MS-DRG	facility	inpatient			Cigna of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 141: Major head and neck procedures with CC	141	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 141: Major head and neck procedures with CC	141	MS-DRG	facility	inpatient			Humana of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 141: Major head and neck procedures with CC	141	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 141: Major head and neck procedures with CC	141	MS-DRG	facility	inpatient			Pacific Source	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 141: Major head and neck procedures with CC	141	MS-DRG	facility	inpatient			Select Health	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 141: Major head and neck procedures with CC	141	MS-DRG	facility	inpatient			Tricare West	Military	60834.78	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 142: Major head and neck procedures without CC/MCC	142	MS-DRG	facility	inpatient			Aetna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 142: Major head and neck procedures without CC/MCC	142	MS-DRG	facility	inpatient			American Health Plans	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 142: Major head and neck procedures without CC/MCC	142	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 142: Major head and neck procedures without CC/MCC	142	MS-DRG	facility	inpatient			Cigna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 142: Major head and neck procedures without CC/MCC	142	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 142: Major head and neck procedures without CC/MCC	142	MS-DRG	facility	inpatient			Humana of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 142: Major head and neck procedures without CC/MCC	142	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 142: Major head and neck procedures without CC/MCC	142	MS-DRG	facility	inpatient			Pacific Source	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 142: Major head and neck procedures without CC/MCC	142	MS-DRG	facility	inpatient			Select Health	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 142: Major head and neck procedures without CC/MCC	142	MS-DRG	facility	inpatient			Tricare West	Military	41788.22	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 143: Other ear, nose, mouth and throat O.R. procedures with MCC	143	MS-DRG	facility	inpatient			Aetna of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 143: Other ear, nose, mouth and throat O.R. procedures with MCC	143	MS-DRG	facility	inpatient			American Health Plans	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 143: Other ear, nose, mouth and throat O.R. procedures with MCC	143	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 143: Other ear, nose, mouth and throat O.R. procedures with MCC	143	MS-DRG	facility	inpatient			Cigna of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 143: Other ear, nose, mouth and throat O.R. procedures with MCC	143	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 143: Other ear, nose, mouth and throat O.R. procedures with MCC	143	MS-DRG	facility	inpatient			Humana of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 143: Other ear, nose, mouth and throat O.R. procedures with MCC	143	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 143: Other ear, nose, mouth and throat O.R. procedures with MCC	143	MS-DRG	facility	inpatient			Pacific Source	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 143: Other ear, nose, mouth and throat O.R. procedures with MCC	143	MS-DRG	facility	inpatient			Select Health	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 143: Other ear, nose, mouth and throat O.R. procedures with MCC	143	MS-DRG	facility	inpatient			Tricare West	Military	60834.78	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 144: Other ear, nose, mouth and throat O.R. procedures with CC	144	MS-DRG	facility	inpatient			Aetna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 144: Other ear, nose, mouth and throat O.R. procedures with CC	144	MS-DRG	facility	inpatient			American Health Plans	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 144: Other ear, nose, mouth and throat O.R. procedures with CC	144	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 144: Other ear, nose, mouth and throat O.R. procedures with CC	144	MS-DRG	facility	inpatient			Cigna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 144: Other ear, nose, mouth and throat O.R. procedures with CC	144	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 144: Other ear, nose, mouth and throat O.R. procedures with CC	144	MS-DRG	facility	inpatient			Humana of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 144: Other ear, nose, mouth and throat O.R. procedures with CC	144	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 144: Other ear, nose, mouth and throat O.R. procedures with CC	144	MS-DRG	facility	inpatient			Pacific Source	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 144: Other ear, nose, mouth and throat O.R. procedures with CC	144	MS-DRG	facility	inpatient			Select Health	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 144: Other ear, nose, mouth and throat O.R. procedures with CC	144	MS-DRG	facility	inpatient			Tricare West	Military	41788.22	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 145: Other ear, nose, mouth and throat O.R. procedures without CC/MCC	145	MS-DRG	facility	inpatient			Aetna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 145: Other ear, nose, mouth and throat O.R. procedures without CC/MCC	145	MS-DRG	facility	inpatient			American Health Plans	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 145: Other ear, nose, mouth and throat O.R. procedures without CC/MCC	145	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 145: Other ear, nose, mouth and throat O.R. procedures without CC/MCC	145	MS-DRG	facility	inpatient			Cigna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 145: Other ear, nose, mouth and throat O.R. procedures without CC/MCC	145	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 145: Other ear, nose, mouth and throat O.R. procedures without CC/MCC	145	MS-DRG	facility	inpatient			Humana of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 145: Other ear, nose, mouth and throat O.R. procedures without CC/MCC	145	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 145: Other ear, nose, mouth and throat O.R. procedures without CC/MCC	145	MS-DRG	facility	inpatient			Pacific Source	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 145: Other ear, nose, mouth and throat O.R. procedures without CC/MCC	145	MS-DRG	facility	inpatient			Select Health	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 145: Other ear, nose, mouth and throat O.R. procedures without CC/MCC	145	MS-DRG	facility	inpatient			Tricare West	Military	41788.22	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 146: Ear, nose, mouth and throat malignancy with MCC*	146	MS-DRG	facility	inpatient			Aetna of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 146: Ear, nose, mouth and throat malignancy with MCC*	146	MS-DRG	facility	inpatient			American Health Plans	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 146: Ear, nose, mouth and throat malignancy with MCC*	146	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 146: Ear, nose, mouth and throat malignancy with MCC*	146	MS-DRG	facility	inpatient			Cigna of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 146: Ear, nose, mouth and throat malignancy with MCC*	146	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 146: Ear, nose, mouth and throat malignancy with MCC*	146	MS-DRG	facility	inpatient			Humana of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 146: Ear, nose, mouth and throat malignancy with MCC*	146	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 146: Ear, nose, mouth and throat malignancy with MCC*	146	MS-DRG	facility	inpatient			Pacific Source	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 146: Ear, nose, mouth and throat malignancy with MCC*	146	MS-DRG	facility	inpatient			Select Health	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 146: Ear, nose, mouth and throat malignancy with MCC*	146	MS-DRG	facility	inpatient			Tricare West	Military	31579.4	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 147: Ear, nose, mouth and throat malignancy with CC	147	MS-DRG	facility	inpatient			Aetna of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 147: Ear, nose, mouth and throat malignancy with CC	147	MS-DRG	facility	inpatient			American Health Plans	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 147: Ear, nose, mouth and throat malignancy with CC	147	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 147: Ear, nose, mouth and throat malignancy with CC	147	MS-DRG	facility	inpatient			Cigna of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 147: Ear, nose, mouth and throat malignancy with CC	147	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 147: Ear, nose, mouth and throat malignancy with CC	147	MS-DRG	facility	inpatient			Humana of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 147: Ear, nose, mouth and throat malignancy with CC	147	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 147: Ear, nose, mouth and throat malignancy with CC	147	MS-DRG	facility	inpatient			Pacific Source	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 147: Ear, nose, mouth and throat malignancy with CC	147	MS-DRG	facility	inpatient			Select Health	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 147: Ear, nose, mouth and throat malignancy with CC	147	MS-DRG	facility	inpatient			Tricare West	Military	31579.4	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 148: Ear, nose, mouth and throat malignancy without CC/MCC	148	MS-DRG	facility	inpatient			Aetna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 148: Ear, nose, mouth and throat malignancy without CC/MCC	148	MS-DRG	facility	inpatient			American Health Plans	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 148: Ear, nose, mouth and throat malignancy without CC/MCC	148	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 148: Ear, nose, mouth and throat malignancy without CC/MCC	148	MS-DRG	facility	inpatient			Cigna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 148: Ear, nose, mouth and throat malignancy without CC/MCC	148	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 148: Ear, nose, mouth and throat malignancy without CC/MCC	148	MS-DRG	facility	inpatient			Humana of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 148: Ear, nose, mouth and throat malignancy without CC/MCC	148	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 148: Ear, nose, mouth and throat malignancy without CC/MCC	148	MS-DRG	facility	inpatient			Pacific Source	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 148: Ear, nose, mouth and throat malignancy without CC/MCC	148	MS-DRG	facility	inpatient			Select Health	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 148: Ear, nose, mouth and throat malignancy without CC/MCC	148	MS-DRG	facility	inpatient			Tricare West	Military	18346.93	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 149: Dysequilibrium	149	MS-DRG	facility	inpatient			Aetna of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 149: Dysequilibrium	149	MS-DRG	facility	inpatient			American Health Plans	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 149: Dysequilibrium	149	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 149: Dysequilibrium	149	MS-DRG	facility	inpatient			Cigna of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 149: Dysequilibrium	149	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 149: Dysequilibrium	149	MS-DRG	facility	inpatient			Humana of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 149: Dysequilibrium	149	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 149: Dysequilibrium	149	MS-DRG	facility	inpatient			Pacific Source	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 149: Dysequilibrium	149	MS-DRG	facility	inpatient			Select Health	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 149: Dysequilibrium	149	MS-DRG	facility	inpatient			Tricare West	Military	24374.12	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 150: Epistaxis with MCC	150	MS-DRG	facility	inpatient			Aetna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 150: Epistaxis with MCC	150	MS-DRG	facility	inpatient			American Health Plans	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 150: Epistaxis with MCC	150	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 150: Epistaxis with MCC	150	MS-DRG	facility	inpatient			Cigna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 150: Epistaxis with MCC	150	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 150: Epistaxis with MCC	150	MS-DRG	facility	inpatient			Humana of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 150: Epistaxis with MCC	150	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 150: Epistaxis with MCC	150	MS-DRG	facility	inpatient			Pacific Source	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 150: Epistaxis with MCC	150	MS-DRG	facility	inpatient			Select Health	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 150: Epistaxis with MCC	150	MS-DRG	facility	inpatient			Tricare West	Military	18346.93	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 151: Epistaxis without MCC	151	MS-DRG	facility	inpatient			Aetna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 151: Epistaxis without MCC	151	MS-DRG	facility	inpatient			American Health Plans	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 151: Epistaxis without MCC	151	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 151: Epistaxis without MCC	151	MS-DRG	facility	inpatient			Cigna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 151: Epistaxis without MCC	151	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 151: Epistaxis without MCC	151	MS-DRG	facility	inpatient			Humana of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 151: Epistaxis without MCC	151	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 151: Epistaxis without MCC	151	MS-DRG	facility	inpatient			Pacific Source	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 151: Epistaxis without MCC	151	MS-DRG	facility	inpatient			Select Health	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 151: Epistaxis without MCC	151	MS-DRG	facility	inpatient			Tricare West	Military	18346.93	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 152: Otitis media and URI with MCC	152	MS-DRG	facility	inpatient			Aetna of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 152: Otitis media and URI with MCC	152	MS-DRG	facility	inpatient			American Health Plans	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 152: Otitis media and URI with MCC	152	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 152: Otitis media and URI with MCC	152	MS-DRG	facility	inpatient			Cigna of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 152: Otitis media and URI with MCC	152	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 152: Otitis media and URI with MCC	152	MS-DRG	facility	inpatient			Humana of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 152: Otitis media and URI with MCC	152	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 152: Otitis media and URI with MCC	152	MS-DRG	facility	inpatient			Pacific Source	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 152: Otitis media and URI with MCC	152	MS-DRG	facility	inpatient			Select Health	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 152: Otitis media and URI with MCC	152	MS-DRG	facility	inpatient			Tricare West	Military	24374.12	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 153: Otitis media and URI without MCC*	153	MS-DRG	facility	inpatient			Aetna of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 153: Otitis media and URI without MCC*	153	MS-DRG	facility	inpatient			American Health Plans	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 153: Otitis media and URI without MCC*	153	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 153: Otitis media and URI without MCC*	153	MS-DRG	facility	inpatient			Cigna of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 153: Otitis media and URI without MCC*	153	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 153: Otitis media and URI without MCC*	153	MS-DRG	facility	inpatient			Humana of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 153: Otitis media and URI without MCC*	153	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 153: Otitis media and URI without MCC*	153	MS-DRG	facility	inpatient			Pacific Source	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 153: Otitis media and URI without MCC*	153	MS-DRG	facility	inpatient			Select Health	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 153: Otitis media and URI without MCC*	153	MS-DRG	facility	inpatient			Tricare West	Military	24374.12	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 154: Other ear, nose, mouth and throat diagnoses with MCC	154	MS-DRG	facility	inpatient			Aetna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 154: Other ear, nose, mouth and throat diagnoses with MCC	154	MS-DRG	facility	inpatient			American Health Plans	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 154: Other ear, nose, mouth and throat diagnoses with MCC	154	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 154: Other ear, nose, mouth and throat diagnoses with MCC	154	MS-DRG	facility	inpatient			Cigna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 154: Other ear, nose, mouth and throat diagnoses with MCC	154	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 154: Other ear, nose, mouth and throat diagnoses with MCC	154	MS-DRG	facility	inpatient			Humana of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 154: Other ear, nose, mouth and throat diagnoses with MCC	154	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 154: Other ear, nose, mouth and throat diagnoses with MCC	154	MS-DRG	facility	inpatient			Pacific Source	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 154: Other ear, nose, mouth and throat diagnoses with MCC	154	MS-DRG	facility	inpatient			Select Health	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 154: Other ear, nose, mouth and throat diagnoses with MCC	154	MS-DRG	facility	inpatient			Tricare West	Military	41788.22	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 155: Other ear, nose, mouth and throat diagnoses with CC	155	MS-DRG	facility	inpatient			Aetna of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 155: Other ear, nose, mouth and throat diagnoses with CC	155	MS-DRG	facility	inpatient			American Health Plans	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 155: Other ear, nose, mouth and throat diagnoses with CC	155	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 155: Other ear, nose, mouth and throat diagnoses with CC	155	MS-DRG	facility	inpatient			Cigna of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 155: Other ear, nose, mouth and throat diagnoses with CC	155	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 155: Other ear, nose, mouth and throat diagnoses with CC	155	MS-DRG	facility	inpatient			Humana of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 155: Other ear, nose, mouth and throat diagnoses with CC	155	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 155: Other ear, nose, mouth and throat diagnoses with CC	155	MS-DRG	facility	inpatient			Pacific Source	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 155: Other ear, nose, mouth and throat diagnoses with CC	155	MS-DRG	facility	inpatient			Select Health	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 155: Other ear, nose, mouth and throat diagnoses with CC	155	MS-DRG	facility	inpatient			Tricare West	Military	24374.12	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 156: Other ear, nose, mouth and throat diagnoses without CC/MCC	156	MS-DRG	facility	inpatient			Aetna of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 156: Other ear, nose, mouth and throat diagnoses without CC/MCC	156	MS-DRG	facility	inpatient			American Health Plans	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 156: Other ear, nose, mouth and throat diagnoses without CC/MCC	156	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 156: Other ear, nose, mouth and throat diagnoses without CC/MCC	156	MS-DRG	facility	inpatient			Cigna of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 156: Other ear, nose, mouth and throat diagnoses without CC/MCC	156	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 156: Other ear, nose, mouth and throat diagnoses without CC/MCC	156	MS-DRG	facility	inpatient			Humana of UT	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 156: Other ear, nose, mouth and throat diagnoses without CC/MCC	156	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 156: Other ear, nose, mouth and throat diagnoses without CC/MCC	156	MS-DRG	facility	inpatient			Pacific Source	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 156: Other ear, nose, mouth and throat diagnoses without CC/MCC	156	MS-DRG	facility	inpatient			Select Health	Medicare	27082.35	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 156: Other ear, nose, mouth and throat diagnoses without CC/MCC	156	MS-DRG	facility	inpatient			Tricare West	Military	24374.12	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.437.412,00	2.708.235,00	fee schedule
MS-LTC-DRG 157: Dental and oral diseases with MCC	157	MS-DRG	facility	inpatient			Aetna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 157: Dental and oral diseases with MCC	157	MS-DRG	facility	inpatient			American Health Plans	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 157: Dental and oral diseases with MCC	157	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 157: Dental and oral diseases with MCC	157	MS-DRG	facility	inpatient			Cigna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 157: Dental and oral diseases with MCC	157	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 157: Dental and oral diseases with MCC	157	MS-DRG	facility	inpatient			Humana of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 157: Dental and oral diseases with MCC	157	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 157: Dental and oral diseases with MCC	157	MS-DRG	facility	inpatient			Pacific Source	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 157: Dental and oral diseases with MCC	157	MS-DRG	facility	inpatient			Select Health	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 157: Dental and oral diseases with MCC	157	MS-DRG	facility	inpatient			Tricare West	Military	41788.22	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 158: Dental and oral diseases with CC	158	MS-DRG	facility	inpatient			Aetna of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 158: Dental and oral diseases with CC	158	MS-DRG	facility	inpatient			American Health Plans	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 158: Dental and oral diseases with CC	158	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 158: Dental and oral diseases with CC	158	MS-DRG	facility	inpatient			Cigna of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 158: Dental and oral diseases with CC	158	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 158: Dental and oral diseases with CC	158	MS-DRG	facility	inpatient			Humana of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 158: Dental and oral diseases with CC	158	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 158: Dental and oral diseases with CC	158	MS-DRG	facility	inpatient			Pacific Source	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 158: Dental and oral diseases with CC	158	MS-DRG	facility	inpatient			Select Health	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 158: Dental and oral diseases with CC	158	MS-DRG	facility	inpatient			Tricare West	Military	31579.4	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 159: Dental and oral diseases without CC/MCC	159	MS-DRG	facility	inpatient			Aetna of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 159: Dental and oral diseases without CC/MCC	159	MS-DRG	facility	inpatient			American Health Plans	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 159: Dental and oral diseases without CC/MCC	159	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 159: Dental and oral diseases without CC/MCC	159	MS-DRG	facility	inpatient			Cigna of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 159: Dental and oral diseases without CC/MCC	159	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 159: Dental and oral diseases without CC/MCC	159	MS-DRG	facility	inpatient			Humana of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 159: Dental and oral diseases without CC/MCC	159	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 159: Dental and oral diseases without CC/MCC	159	MS-DRG	facility	inpatient			Pacific Source	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 159: Dental and oral diseases without CC/MCC	159	MS-DRG	facility	inpatient			Select Health	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 159: Dental and oral diseases without CC/MCC	159	MS-DRG	facility	inpatient			Tricare West	Military	31579.4	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 163: Major chest procedures with MCC	163	MS-DRG	facility	inpatient			Aetna of UT	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 163: Major chest procedures with MCC	163	MS-DRG	facility	inpatient			American Health Plans	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 163: Major chest procedures with MCC	163	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 163: Major chest procedures with MCC	163	MS-DRG	facility	inpatient			Cigna of UT	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 163: Major chest procedures with MCC	163	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 163: Major chest procedures with MCC	163	MS-DRG	facility	inpatient			Humana of UT	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 163: Major chest procedures with MCC	163	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 163: Major chest procedures with MCC	163	MS-DRG	facility	inpatient			Pacific Source	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 163: Major chest procedures with MCC	163	MS-DRG	facility	inpatient			Select Health	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 163: Major chest procedures with MCC	163	MS-DRG	facility	inpatient			Tricare West	Military	106499.06	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 164: Major chest procedures with CC	164	MS-DRG	facility	inpatient			Aetna of UT	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 164: Major chest procedures with CC	164	MS-DRG	facility	inpatient			American Health Plans	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 164: Major chest procedures with CC	164	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 164: Major chest procedures with CC	164	MS-DRG	facility	inpatient			Cigna of UT	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 164: Major chest procedures with CC	164	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 164: Major chest procedures with CC	164	MS-DRG	facility	inpatient			Humana of UT	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 164: Major chest procedures with CC	164	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 164: Major chest procedures with CC	164	MS-DRG	facility	inpatient			Pacific Source	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 164: Major chest procedures with CC	164	MS-DRG	facility	inpatient			Select Health	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 164: Major chest procedures with CC	164	MS-DRG	facility	inpatient			Tricare West	Military	106499.06	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 165: Major chest procedures without CC/MCC	165	MS-DRG	facility	inpatient			Aetna of UT	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 165: Major chest procedures without CC/MCC	165	MS-DRG	facility	inpatient			American Health Plans	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 165: Major chest procedures without CC/MCC	165	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 165: Major chest procedures without CC/MCC	165	MS-DRG	facility	inpatient			Cigna of UT	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 165: Major chest procedures without CC/MCC	165	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 165: Major chest procedures without CC/MCC	165	MS-DRG	facility	inpatient			Humana of UT	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 165: Major chest procedures without CC/MCC	165	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 165: Major chest procedures without CC/MCC	165	MS-DRG	facility	inpatient			Pacific Source	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 165: Major chest procedures without CC/MCC	165	MS-DRG	facility	inpatient			Select Health	Medicare	118332.29	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 165: Major chest procedures without CC/MCC	165	MS-DRG	facility	inpatient			Tricare West	Military	106499.06	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	10.649.906,00	11.833.229,00	fee schedule
MS-LTC-DRG 166: Other respiratory system O.R. procedures with MCC	166	MS-DRG	facility	inpatient			Aetna of UT	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 166: Other respiratory system O.R. procedures with MCC	166	MS-DRG	facility	inpatient			American Health Plans	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 166: Other respiratory system O.R. procedures with MCC	166	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 166: Other respiratory system O.R. procedures with MCC	166	MS-DRG	facility	inpatient			Cigna of UT	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 166: Other respiratory system O.R. procedures with MCC	166	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 166: Other respiratory system O.R. procedures with MCC	166	MS-DRG	facility	inpatient			Humana of UT	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 166: Other respiratory system O.R. procedures with MCC	166	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 166: Other respiratory system O.R. procedures with MCC	166	MS-DRG	facility	inpatient			Pacific Source	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 166: Other respiratory system O.R. procedures with MCC	166	MS-DRG	facility	inpatient			Select Health	Medicare	103642.95	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 166: Other respiratory system O.R. procedures with MCC	166	MS-DRG	facility	inpatient			Tricare West	Military	93278.66	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	9.327.866,00	10.364.295,00	fee schedule
MS-LTC-DRG 167: Other respiratory system O.R. procedures with CC	167	MS-DRG	facility	inpatient			Aetna of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 167: Other respiratory system O.R. procedures with CC	167	MS-DRG	facility	inpatient			American Health Plans	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 167: Other respiratory system O.R. procedures with CC	167	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 167: Other respiratory system O.R. procedures with CC	167	MS-DRG	facility	inpatient			Cigna of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 167: Other respiratory system O.R. procedures with CC	167	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 167: Other respiratory system O.R. procedures with CC	167	MS-DRG	facility	inpatient			Humana of UT	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 167: Other respiratory system O.R. procedures with CC	167	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 167: Other respiratory system O.R. procedures with CC	167	MS-DRG	facility	inpatient			Pacific Source	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 167: Other respiratory system O.R. procedures with CC	167	MS-DRG	facility	inpatient			Select Health	Medicare	67594.2	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 167: Other respiratory system O.R. procedures with CC	167	MS-DRG	facility	inpatient			Tricare West	Military	60834.78	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	6.083.478,00	675.942,00	fee schedule
MS-LTC-DRG 168: Other respiratory system O.R. procedures without CC/MCC	168	MS-DRG	facility	inpatient			Aetna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 168: Other respiratory system O.R. procedures without CC/MCC	168	MS-DRG	facility	inpatient			American Health Plans	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 168: Other respiratory system O.R. procedures without CC/MCC	168	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 168: Other respiratory system O.R. procedures without CC/MCC	168	MS-DRG	facility	inpatient			Cigna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 168: Other respiratory system O.R. procedures without CC/MCC	168	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 168: Other respiratory system O.R. procedures without CC/MCC	168	MS-DRG	facility	inpatient			Humana of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 168: Other respiratory system O.R. procedures without CC/MCC	168	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 168: Other respiratory system O.R. procedures without CC/MCC	168	MS-DRG	facility	inpatient			Pacific Source	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 168: Other respiratory system O.R. procedures without CC/MCC	168	MS-DRG	facility	inpatient			Select Health	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 168: Other respiratory system O.R. procedures without CC/MCC	168	MS-DRG	facility	inpatient			Tricare West	Military	41788.22	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 173: Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism	173	MS-DRG	facility	inpatient			Aetna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 173: Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism	173	MS-DRG	facility	inpatient			American Health Plans	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 173: Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism	173	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 173: Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism	173	MS-DRG	facility	inpatient			Cigna of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 173: Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism	173	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 173: Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism	173	MS-DRG	facility	inpatient			Humana of UT	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 173: Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism	173	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 173: Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism	173	MS-DRG	facility	inpatient			Pacific Source	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 173: Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism	173	MS-DRG	facility	inpatient			Select Health	Medicare	46431.36	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 173: Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism	173	MS-DRG	facility	inpatient			Tricare West	Military	41788.22	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	4.178.822,00	4.643.136,00	fee schedule
MS-LTC-DRG 175: Pulmonary embolism with MCC or acute cor pulmonale	175	MS-DRG	facility	inpatient			Aetna of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 175: Pulmonary embolism with MCC or acute cor pulmonale	175	MS-DRG	facility	inpatient			American Health Plans	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 175: Pulmonary embolism with MCC or acute cor pulmonale	175	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 175: Pulmonary embolism with MCC or acute cor pulmonale	175	MS-DRG	facility	inpatient			Cigna of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 175: Pulmonary embolism with MCC or acute cor pulmonale	175	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 175: Pulmonary embolism with MCC or acute cor pulmonale	175	MS-DRG	facility	inpatient			Humana of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 175: Pulmonary embolism with MCC or acute cor pulmonale	175	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 175: Pulmonary embolism with MCC or acute cor pulmonale	175	MS-DRG	facility	inpatient			Pacific Source	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 175: Pulmonary embolism with MCC or acute cor pulmonale	175	MS-DRG	facility	inpatient			Select Health	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 175: Pulmonary embolism with MCC or acute cor pulmonale	175	MS-DRG	facility	inpatient			Tricare West	Military	31579.4	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,00	fee schedule
MS-LTC-DRG 176: Pulmonary embolism without MCC	176	MS-DRG	facility	inpatient			Aetna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 176: Pulmonary embolism without MCC	176	MS-DRG	facility	inpatient			American Health Plans	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 176: Pulmonary embolism without MCC	176	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 176: Pulmonary embolism without MCC	176	MS-DRG	facility	inpatient			Cigna of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 176: Pulmonary embolism without MCC	176	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 176: Pulmonary embolism without MCC	176	MS-DRG	facility	inpatient			Humana of UT	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 176: Pulmonary embolism without MCC	176	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 176: Pulmonary embolism without MCC	176	MS-DRG	facility	inpatient			Pacific Source	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 176: Pulmonary embolism without MCC	176	MS-DRG	facility	inpatient			Select Health	Medicare	20385.48	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 176: Pulmonary embolism without MCC	176	MS-DRG	facility	inpatient			Tricare West	Military	18346.93	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	1.834.693,00	2.038.548,00	fee schedule
MS-LTC-DRG 177: Respiratory infections and inflammations with MCC	177	MS-DRG	facility	inpatient			Aetna of UT	Medicare	36736.75	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	3.306.308,00	3.673.675,00	fee schedule
MS-LTC-DRG 177: Respiratory infections and inflammations with MCC	177	MS-DRG	facility	inpatient			American Health Plans	Medicare	36736.75	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	3.306.308,00	3.673.675,00	fee schedule
MS-LTC-DRG 177: Respiratory infections and inflammations with MCC	177	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	36736.75	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	3.306.308,00	3.673.675,00	fee schedule
MS-LTC-DRG 177: Respiratory infections and inflammations with MCC	177	MS-DRG	facility	inpatient			Cigna of UT	Medicare	36736.75	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	3.306.308,00	3.673.675,00	fee schedule
MS-LTC-DRG 177: Respiratory infections and inflammations with MCC	177	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	36736.75	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	3.306.308,00	3.673.675,00	fee schedule
MS-LTC-DRG 177: Respiratory infections and inflammations with MCC	177	MS-DRG	facility	inpatient			Humana of UT	Medicare	36736.75	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	3.306.308,00	3.673.675,00	fee schedule
MS-LTC-DRG 177: Respiratory infections and inflammations with MCC	177	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	36736.75	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	3.306.308,00	3.673.675,00	fee schedule
MS-LTC-DRG 177: Respiratory infections and inflammations with MCC	177	MS-DRG	facility	inpatient			Pacific Source	Medicare	36736.75	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	3.306.308,00	3.673.675,00	fee schedule
MS-LTC-DRG 177: Respiratory infections and inflammations with MCC	177	MS-DRG	facility	inpatient			Select Health	Medicare	36736.75	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	3.306.308,00	3.673.675,00	fee schedule
MS-LTC-DRG 177: Respiratory infections and inflammations with MCC	177	MS-DRG	facility	inpatient			Tricare West	Military	33063.08	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	3.306.308,00	3.673.675,00	fee schedule
MS-LTC-DRG 178: Respiratory infections and inflammations with CC*	178	MS-DRG	facility	inpatient			Aetna of UT	Medicare	25393.62	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.285.426,00	2.539.362,00	fee schedule
MS-LTC-DRG 178: Respiratory infections and inflammations with CC*	178	MS-DRG	facility	inpatient			American Health Plans	Medicare	25393.62	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.285.426,00	2.539.362,00	fee schedule
MS-LTC-DRG 178: Respiratory infections and inflammations with CC*	178	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	25393.62	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.285.426,00	2.539.362,00	fee schedule
MS-LTC-DRG 178: Respiratory infections and inflammations with CC*	178	MS-DRG	facility	inpatient			Cigna of UT	Medicare	25393.62	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.285.426,00	2.539.362,00	fee schedule
MS-LTC-DRG 178: Respiratory infections and inflammations with CC*	178	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	25393.62	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.285.426,00	2.539.362,00	fee schedule
MS-LTC-DRG 178: Respiratory infections and inflammations with CC*	178	MS-DRG	facility	inpatient			Humana of UT	Medicare	25393.62	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.285.426,00	2.539.362,00	fee schedule
MS-LTC-DRG 178: Respiratory infections and inflammations with CC*	178	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	25393.62	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.285.426,00	2.539.362,00	fee schedule
MS-LTC-DRG 178: Respiratory infections and inflammations with CC*	178	MS-DRG	facility	inpatient			Pacific Source	Medicare	25393.62	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.285.426,00	2.539.362,00	fee schedule
MS-LTC-DRG 178: Respiratory infections and inflammations with CC*	178	MS-DRG	facility	inpatient			Select Health	Medicare	25393.62	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.285.426,00	2.539.362,00	fee schedule
MS-LTC-DRG 178: Respiratory infections and inflammations with CC*	178	MS-DRG	facility	inpatient			Tricare West	Military	22854.26	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.285.426,00	2.539.362,00	fee schedule
MS-LTC-DRG 179: Respiratory infections and inflammations without CC/MCC*	179	MS-DRG	facility	inpatient			Aetna of UT	Medicare	24669.87	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.220.288,00	2.466.987,00	fee schedule
MS-LTC-DRG 179: Respiratory infections and inflammations without CC/MCC*	179	MS-DRG	facility	inpatient			American Health Plans	Medicare	24669.87	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.220.288,00	2.466.987,00	fee schedule
MS-LTC-DRG 179: Respiratory infections and inflammations without CC/MCC*	179	MS-DRG	facility	inpatient			Blue Cross of UT	Medicare	24669.87	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.220.288,00	2.466.987,00	fee schedule
MS-LTC-DRG 179: Respiratory infections and inflammations without CC/MCC*	179	MS-DRG	facility	inpatient			Cigna of UT	Medicare	24669.87	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.220.288,00	2.466.987,00	fee schedule
MS-LTC-DRG 179: Respiratory infections and inflammations without CC/MCC*	179	MS-DRG	facility	inpatient			HealthChoice UT	Medicare	24669.87	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.220.288,00	2.466.987,00	fee schedule
MS-LTC-DRG 179: Respiratory infections and inflammations without CC/MCC*	179	MS-DRG	facility	inpatient			Humana of UT	Medicare	24669.87	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.220.288,00	2.466.987,00	fee schedule
MS-LTC-DRG 179: Respiratory infections and inflammations without CC/MCC*	179	MS-DRG	facility	inpatient			Molina of UT	Commercial/Medicare	24669.87	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.220.288,00	2.466.987,00	fee schedule
MS-LTC-DRG 179: Respiratory infections and inflammations without CC/MCC*	179	MS-DRG	facility	inpatient			Pacific Source	Medicare	24669.87	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.220.288,00	2.466.987,00	fee schedule
MS-LTC-DRG 179: Respiratory infections and inflammations without CC/MCC*	179	MS-DRG	facility	inpatient			Select Health	Medicare	24669.87	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.220.288,00	2.466.987,00	fee schedule
MS-LTC-DRG 179: Respiratory infections and inflammations without CC/MCC*	179	MS-DRG	facility	inpatient			Tricare West	Military	22202.88	LTAC services are reimbursed at 90% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	2.220.288,00	2.466.987,00	fee schedule
MS-LTC-DRG 180: Respiratory neoplasms with MCC	180	MS-DRG	facility	inpatient			Aetna of UT	Medicare	35088.22	LTAC services are reimbursed at 100% of the CMS Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) rate. This rate is adjusted based on the Medicare Severity Long-Term Care Diagnosis-Related Group (MS-LTC-DRG) assigned to the patient, which takes into account the severity of illness, the expected resource needs, and the length of stay.	315.794,00	3.508.822,0