The CDM file is a hospital's regularly updated database containing the list of standard charges (i.e. “list prices”) assigned to procedures, services, drugs, and supplies associated with the delivery of medical care at that hospital or facility. Standard charges are standard dollar amount that a UPMC hospital sets for services rendered before negotiating any discounts. It is important to note that the standard charge is not the amount that a patient is expected to pay for receiving health care services. A patient’s financial obligation is determined by many factors, including insurance coverage and benefit plan limits.
Patients seeking an estimate of the out-of-pocket amount that you will be expected to pay for receiving health care services should contact the UPMC Price Estimator team at 1-800-371-8359, option 5. If you need help for paying your health care costs, please see the Financial Services web page for more information on financial assistance, screening for medical assistance, and payment plans.
Please see the Frequently Asked Questions section below for more information on the Charge Description Master (CDM) file.
The UPMC Horizon CDM file is downloadable is MS Excel format. Per regulations issued from the Centers for Medicare and Medicaid Services, this file will be updated at least annually.
Each row of the CDM file contains information regarding a certain medical service, surgical procedure, supply item, or drug. The first column of each row contains the name of the hospital, the second column of each row contains the description of the medical service, surgical procedure, supply item, or drug, and the third column of each row contains the standard base charge for that item.
Patients seeking to understand their out-of-pocket costs, see the Financial Services We Offer web page for information on price estimates, financial assistance, and payment plans.
The Charge Description Master (CDM) file is a hospital’s regularly updated database containing the list of Standard Charges assigned to procedures, services, drugs, and supplies associated with the delivery of medical care at that hospital or facility.
The standard dollar amount a UPMC provider sets for services rendered before negotiating any discounts. The charge can be – and often is – different from the amount paid.
Standard charges are reflective of the clinical services directly involved in your care (e.g. nurses, technicians, and other staff providing care), as well as the drugs and supplies used to provide care. Standard charges also reflect support areas not directly related to your care such as housekeeping, facilities maintenance, information technology, medical records, etc.
Additionally, hospital charges allow for future investments cutting-edge diagnostic and therapeutic services, improvements to hospital facilities, and the expansion of clinical programs & services that are needed to provide world-class medical care.
No, the standard charge amount assigned in the CDM is the same regardless of type of insurance or payer coverage. All patients at a hospital receive the same charge amount for the same service.
No, if you have in-network insurance coverage your out-of-pocket payment responsibility is based on the benefits of your insurance plan. Your insurance determines the copay, coinsurance, and deductible amounts that you will be responsible for paying out-of-pocket. Copay, coinsurance, and deductible amounts are determined by your insurance company and are not affected by standard charges.
Similarly, your coinsurance and deductible amounts are determined by the contracted payment rates your insurance company has made with the hospital (called the “allowable”), not on the standard charge in the CDM.
Because your insurance plan benefits determine your out-of-pocket costs and payment for your services is based upon contracted rates, the hospital CDM file of standard charges is not a useful tool for determining out-of-pocket cost that you will pay for your health care.
If you would like an estimate of how much a procedure will cost before you schedule your appointment, please contact the UPMC Price Estimator team and ask for an estimate for the cost of your planned services.
Please call 1-800-371-8359 option 5 to request a price estimate.
Note that the actual amount of your out-of-pocket costs for UPMC services included in the estimate may be greater or less than the estimate provided to you via the UPMC Price Estimator team for such services or procedures.
If you have insurance that is not contracted with UPMC, please contact your insurance company for more information on out-of-network benefits. You can also contact the UPMC Price Estimator team for an estimate of out-of-pocket costs as well.
No – standard charges do not reflect your out-of-pocket cost for nearly all hospital clinical services and visit types.
For patients who have no insurance, there are multiple options for providing help for paying your health care costs. Please see UPMC’s Financial Services web page for more information on financial assistance, screening for medical assistance, and payment plans.
Pursuant to the 2020 Hospital Outpatient Prospective Payment System (OPPS) rule issued by Centers for Medicare and Medicaid Services (CMS), UPMC Horizon is providing online access to a Machine-Readable file of Items and Services in JSON format. “Machine-readable” means that the data file can be easily processed by a computer. The JSON format is one of the file formats approved by CMS, and is a frequently used, standardized file format for data exchange. Consistent with these regulations issued by CMS, this file will be updated at least annually.
For each hospital item or service provided to patients, the Machine Readable File of Items and Services specifies the hospital standard (gross) charge, discounted cash price (for an individual who pays cash), and the minimum and maximum charge that a hospital has negotiated with a third-party payer. Additionally, this file contains payer-specific negotiated charge amounts as required by CMS.
It is important to note that contracts negotiated between hospitals and payers use many different, and frequently unique, reimbursement methodologies. Hospital reimbursements for clinical services, i.e., charges, may be conditionally paid based on other services provided, or bundled into the payment for other services. Reimbursements also may vary due to other negotiated, complex criteria specific to particular payer contracts. Consequently, using the Machine Readable File of Items and Services to conduct comparisons of contracted payment rates for specific line items across payers may not accurately reflect total contracted reimbursement rates.