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UPMC St. Margaret Standard Charges

Understanding the Charge Description Master (CDM) File

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.

Charge Description Master (CDM) File

The UPMC St. Margaret 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.

CDM Frequently Asked Questions (FAQ’s)

Machine Readable File of Items and Services

Pursuant to the 2020 Hospital Outpatient Prospective Payment System (OPPS) rule issued by Centers for Medicare and Medicaid Services (CMS), UPMC St. Margaret 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.

Download the UPMC St. Margaret Machine Readable File of Items and Services