OPPS APC Payment Estimate

OPPS APC payment estimate: relative weight x conversion factor, wage adjusted.

Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.

Example

APC lines, one per line as "weight, status indicator": 10, T 4, T 2, N
OPPS conversion factor: 87 $ per weight unit
Wage index: 1

Result: Total OPPS payment $1044.00: $870.00 + $174.00 (status T discounted to 50%); the status N line is packaged at $0.00.

The tool opens with these values already filled in. Replace them with your own.

What you enter

APC lines, one per line as "weight, status indicator" (e.g. "10, T")
OPPS conversion factor
Wage index (default 1.0)
Multiple-procedure discount %, default 50

How this is calculated

42 CFR Part 419 (OPPS): the APC payment = relative weight x the OPPS conversion factor, wage adjusted, with status-indicator packaging and the multiple-procedure discount on lower-weighted procedures. CMS OPPS Final Rule; the APC relative-weight table. Estimates the base model only. Read the source ↗

A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.