Review this entire data dictionary for how to disclose data elements in CSV and find the CSV "Tall" template here and CSV "Wide" template here to begin building your hospital MRF. For an explanation of how to interpret the data element tables, review the How to Read the Data Dictionary Tables information.
Developers of machine-readable files (MRFs) should generally consider and adopt established standards and industry norms for CSV files when creating the MRF. For more information on CSV standards visit https://www.rfc-editor.org/rfc/rfc4180.
For CSV, hospitals may choose either a “wide” or “tall” layout. The CSV MRF must be saved as plaintext data separated by commas (“,”) and not use other delimiters. Below are additional reminders to avoid common errors in MRFs:
- Do not insert a value or any type of indicators (e.g., “N/A”) if the hospital does not have applicable data to encode. If you would like to include an explanation for the blanks, you may do so using Additional Generic Notes or Additional Payer-Specific Notes.
- Encode valid values as instructed below. Values encoded incorrectly will generate a deficiency.
- For example, if the valid value is ‘numeric’ (such as for Payer-Specific Negotiated Charge: Dollar Amount), inserting anything other than a number (such as inserting a dollar sign with a number) will generate a deficiency. Similarly, if the valid value is ‘enum’ (such as for Code Type), inserting anything other than the values indicated (such as inserting ‘other’) will generate a deficiency.
- All "Numeric" data elements must be positive numbers. Entering a negative number or "0" will generate a deficiency.
- While GitHub examples exclude leading and trailing spaces in headers, valid values, and around pipes, inadvertently inserting spaces will not generate a deficiency. Similarly, while GitHub examples may use capital and lower-case letters, valid values are case-insensitive and changes in capital vs lower-case letters will not generate a deficiency.
- Hospitals are permitted to include additional optional information through optional data elements that are defined in the data dictionary (e.g., billing class and hospital financial aid policy) or hospital created data elements. Follow the technical instructions for including the defined optional data elements.
- Ensure all conditional requirements are met for an MRF to be considered valid.
- Do not repeat column headers in row 1 and 3. Ensure each header is unique.
Encode the headers and valid values according to the data element implementation timeline in the HPT regulation (45 CFR § 180.50) as finalized in the CY2024 OPPS/ASC final rule.
These required general data elements about the MRF must be stated once at the top of the file (i.e. the first row).
| Column Header (Tall format) | Column Header (Wide format) | Name | Type | Description | Blanks Accepted |
|---|---|---|---|---|---|
| hospital_name | hospital_name | Hospital Name | String | The legal business name of the licensee. | No |
| last_updated_on | last_updated_on | MRF Date | Date | Date on which the MRF was last updated. Date must be in an ISO 8601 format (i.e. YYYY-MM-DD). See additional last updated on notes | No |
| version | version | CMS Template Version | String | The version of the CMS Template used. | No |
| hospital_location | hospital_location | Hospital Location(s) | String | The unique name of the hospital location absent any acronyms. | No |
| hospital_address | hospital_address | Hospital Address(es) | String | The geographic address of the corresponding hospital location. See additional hospital address notes | No |
| license_number | [state] | license_number | [state] | Hospital Licensure Information | String | The hospital license number and the licensing state or territory’s two-letter abbreviation for the hospital location(s) indicated in the file. See additional csv placeholder notes for implementation details. | Yes |
| Header is Affirmation Statement | Header is Affirmation Statement | Affirmation Statement | Boolean | Required affirmation statement. Valid values: true and false. See additional affirmation notes for more details. |
No |
ISO 8601 is the required format but the M/D/YYYY (e.g., 7/1/2024) or MM/DD/YYYY (e.g., 07/01/2024) formats are also accepted for the last_updated_on data element in CSV "Tall" or "Wide" MRFs.
If the MRF contains identical standard charges for multiple hospital locations, separate the address of each location with a “|”. List the addresses in the same sequential order as the hospital_location values for the data element above (see examples). Address(es) must be included for, at minimum, all inpatient facilities and stand-alone emergency departments. Each hospital location operating under a single hospital license (or approval) that has a different set of standard charges than the other location(s) operating under the same hospital license (or approval) must separately make public the standard charges applicable to that location.
The affirmation data element for CSV will require the following text in the column header:
To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.
The value to be encoded by the hospital will either be "true" or "false". Please see the column header in the CSV template here
After the general data elements have been disclosed, the disclosure of required standard charges, item/service, and coding data elements will begin on row 3.
If a -- is encountered in the following table, then the instruction does not apply to the specific CMS template selected. You can view both CSV templates here.
| Column Header (Tall format) | Column Header (Wide format) | Name | Type | Description | Blanks Accepted |
|---|---|---|---|---|---|
| description | description | General Description | String | Description of each item or service provided by the hospital that corresponds to the standard charge the hospital has established. | No |
| code | [i] | code | [i] | Billing/Account Code(s) | String | Any code(s) used by the hospital for purposes of billing or accounting for the item or service. See additional csv placeholder notes for implementation details. | Yes |
| code | [i] | type | code | [i] | type | Code Type(s) | Enum | The corresponding coding type for the code data element. Please see a list of the valid values and additional csv placeholder notes for implementation details. |
Yes |
| setting | setting | Setting | Enum | Indicates whether the item or service is provided in connection with an inpatient admission or an outpatient department visit. Valid values: "inpatient", "outpatient", "both". | No |
| drug_unit_of_measurement | drug_unit_of_measurement | Drug Unit of Measurement | Numeric | If the item or service is a drug, indicate the unit value that corresponds to the established standard charge. | Yes |
| drug_type_of_measurement | drug_type_of_measurement | Drug Type of Measurement | Enum | The measurement type that corresponds to the established standard charge for drugs as defined by either the National Drug Code or the National Council for Prescription Drug Programs. See the list of valid values. | Yes |
| standard_charge | gross | standard_charge | gross | Gross Charge | Numeric | Gross charge is the charge for an individual item or service that is reflected on a hospital’s chargemaster, absent any discounts. | Yes |
| standard_charge | discounted_cash | standard_charge | discounted_cash | Discounted Cash Price | Numeric | Discounted cash price is defined as the charge that applies to an individual who pays cash (or cash equivalent) for a hospital item or service. | Yes |
| payer_name | -- | Payer Name | String | The name of the third-party payer that is, by statute, contract, or agreement, legally responsible for payment of a claim for a healthcare item or service. | Yes |
| plan_name | -- | Plan Name | String | The name of the payer’s specific plan associated with the standard charge. | Yes |
| modifiers | modifiers | Modifier(s) | String | Include any modifier(s) that may change the standard charge that corresponds to hospital items or services. | Yes |
| standard_charge | negotiated_dollar | standard_charge | [payer_name] | [plan_name] | negotiated_dollar | Payer-specific Negotiated Charge: Dollar Amount | Numeric | Payer-specific negotiated charge (expressed as a dollar amount) that a hospital has negotiated with a third-party payer for the corresponding item or service. See additional csv placeholder notes for implementation details. | Yes |
| standard_charge | negotiated_percentage | standard_charge | [payer_name] | [plan_name] | negotiated_percentage | Payer-specific Negotiated Charge: Percentage | Numeric | Payer-specific negotiated charge (expressed as a percentage) that a hospital has negotiated with a third-party payer for an item or service. See additional csv placeholder notes for implementation details and additional notes for percentage for disclosure details. | Yes |
| standard_charge | negotiated_algorithm | standard_charge | [payer_name] | [plan_name] | negotiated_algorithm | Payer-specific Negotiated Charge: Algorithm | String | Payer-specific negotiated charge (expressed as an algorithm) that a hospital has negotiated with a third-party payer for the corresponding item or service. See additional csv placeholder notes for implementation details. | Yes |
| estimated_amount | estimated_amount | [payer_name] | [plan_name] | Estimated Allowed Amount | Numeric | Estimated allowed amount means the average dollar amount that the hospital has historically received from a third party payer for an item or service. If the standard charge is based on a percentage or algorithm, the MRF must also specify the estimated allowed amount for that item or service. See additional estimated amount notes for more information. | Yes |
| standard_charge | min | standard_charge | min | De-identified Minimum Negotiated Charge | Numeric | De-identified minimum negotiated charge is the lowest charge that a hospital has negotiated with all third-party payers for an item or service. This is determined from the set of negotiated standard charge dollar amounts. | Yes |
| standard_charge | max | standard_charge | max | De-identified Maximum Negotiated Charge | Numeric | De-identified maximum negotiated charge is the highest charge that a hospital has negotiated with all third-party payers for an item or service. This is determined from the set of negotiated standard charge dollar amounts. | Yes |
| standard_charge | methodology | standard_charge | [payer_name] | [plan_name] | methodology | Standard Charge Methodology | Enum | Method used to establish the payer-specific negotiated charge. The valid value corresponds to the contract arrangement. See additional standard charge methodology notes and valid values for more information and additional csv placeholder notes for implementation details. | Yes |
| additional_generic_notes | additional_generic_notes | Additional Generic Notes | String | A free text data element that is used to help explain any of the data including, for example, blanks due to no applicable data, charity care policies, or other contextual information that aids in the public’s understanding of the standard charges. See additional-generic-notes-notes for more details. | Yes |
| -- | additional_payer_notes | [payer_name] | [plan_name] | Additional Payer-Specific Notes | String | A free text data element used to help explain data in the file that is related to a payer-specific negotiated charge. See additional csv placeholder notes for implementation details. | Yes |
Information for this data element should be encoded only when the payer-specific negotiated charge has been established as a percentage and no standard dollar amount can be calculated. This data element will contain the numeric representation of the percentage not as a decimal (70.5% is to be entered as “70.5” and not “.705”). If you encode information for this data element, you must also calculate and encode a corresponding estimated allowed amount for that item or service.
CMS recommends that the hospital encode 999999999 (nine 9s) in the data element value to indicate that there is not sufficient historic claims history to derive the estimated allowed amount, and then update the file when sufficient history is available. As a guide for the threshold for sufficient history, we suggest hospitals use the CMS Cell Suppression Policy established in January, 2020. Additionally if the hospital wishes to provide further context for the lack of data they can do so in the appropriate additional notes field.
The following valid values for drug_type_of_measurement are based on two sets of industry standards; National Drug Code and National Council for Prescription Drug Programs.
| Standard Name | Valid Value |
|---|---|
| Grams | GR |
| Milligrams | ME |
| Milliliters | ML |
| Unit | UN |
| International Unit | F2 |
| Each | EA |
| Gram | GM |
If using the CSV Tall template, this data element can be used for both additional payer-specific and general information about the standard charge for an item or service.
If using the CSV Wide template, use the ‘Additional Generic Notes’ data element for additional general information and use the ‘Additional Payer-Specific Notes’ data element for additional payer-specific information.
There are a few CSV data elements that have placeholders that must be updated by the developer of the MRF. Placeholders can be identified as an item in brackets [ ] and are found in column headers (rows 1 and 3). For example, both data elements standard_charge | [payer_name] | [plan_name] | algorithm and code | [i] on row 3 contain placeholders that must be replaced with valid values.
There are four different types of placeholders in the MRF: [state], [i], [plan_name], and [payer_name].
[state]must be replaced by the 2-letter state code such as CA or NY. For example, the column header on row 1,license_number|[state]would be updated tolicense_number|CAfor a hospital licensed by the state of California.[i]is a CSV header placeholder that must be replaced with numbers starting at “1”, increasing by one to however many columns of codes are needed, and matching the associated code type header. For example, if two code and code type combinations are needed, the first header iscode|1and the second header iscode|2.[plan_name]must be replaced by the specific plan name for the payer with whom the hospital has negotiated a payer-specific negotiated charge.[payer_name]must be replaced by the name of the payer with whom the hospital has negotiated a payer-specific negotiated charge.- See examples of how to update placeholders here.
Note: Six standard charge data elements in the CSV “Wide” template contain payer name and plan name placeholders (specifically: Payer-specific Negotiated Charge: Dollar Amount, Payer-specific Negotiated Charge: Percentage, Payer-specific Negotiated Charge: Algorithm, Estimated Allowed Amount, Standard Charge Methodology, and Additional Payer-Specific Notes). If a hospital encodes one payer and plan combination into any of the six standard charge data element headers, the remaining payer-specific headers for that payer and plan combination are also required to be included in row 3, regardless of whether the hospital has applicable standard charge information to encode for the remaining headers.
The methodology data element describes the method used by the hospital to establish a payer-specific negotiated charge. Below are definitions for the valid values for the methodology data element and illustrative examples for how to represent unique contracting scenarios in combination with other data elements.
Encode the value that most closely represents the standard charge methodology for the payer-specific negotiated charge for an associated item or service. If the standard charge methodology the hospital has used isn’t represented in the definitions, encode other along with a detailed explanation of the contracting arrangement in the additional_generic_notes for the CSV Tall template or the additional_payer_notes for the CSV Wide template.
case rate: A flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.fee schedule: The payer-specific negotiated charge is based on a fee schedule. Examples of common fee schedules include Medicare, Medicaid, commercial payer, and workers compensation. The dollar amount that is based on the indicated fee schedule should be encoded into thePayer-specific Negotiated Charge: Dollar Amountdata element. For standard charges based on a percentage of a known fee schedule, the dollar amount should be calculated and encoded in thePayer-specific Negotiated Charge: Dollar Amountdata element.percent of total billed charges: The payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service. This percentage may vary depending on certain pre-determined criteria being met.per diem: The per day charge for providing hospital items and services.other: If the standard charge methodology used to establish a payer-specific negotiated charge cannot be described by one of the types of standard charge methodology above, select ‘Other’ and encode a detailed explanation of the contracting arrangement in theadditional_generic_notesfor the CSV Tall template or theadditional_payer_notesfor the CSV Wide template.
Hospital items and services may be associated with a variety of billing codes or accounting codes. Examples include Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), National Drug Code (NDC), Revenue Center (RC) code, or other common payer identifier. The list of valid values is in the following table with the name of the standard and the associated valid values.
The value "LOCAL" may be used for internal accounting codes in conjunction with another billing code for that item or service. However, if no other code types are available for a particular item or service, "LOCAL" may be used as a valid value.
| Standard Name | Valid Value |
|---|---|
| Current Procedural Terminology | CPT |
| National Drug Code | NDC |
| Healthcare Common Procedural Coding System | HCPCS |
| Revenue Code | RC |
| International Classification of Diseases | ICD |
| Diagnosis Related Groups | DRG |
| Medicare Severity Diagnosis Related Groups | MS-DRG |
| Refined Diagnosis Related Groups | R-DRG |
| Severity Diagnosis Related Groups | S-DRG |
| All Patient, Severity-Adjusted Diagnosis Related Groups | APS-DRG |
| All Patient Diagnosis Related Groups | AP-DRG |
| All Patient Refined Diagnosis Related Groups | APR-DRG |
| Ambulatory Payment Classifications | APC |
| Local Code Processing | LOCAL |
| Enhanced Ambulatory Patient Grouping | EAPG |
| Health Insurance Prospective Payment System | HIPPS |
| Current Dental Terminology | CDT |
| Charge Description Master (chargemaster) | CDM |
| TriCare Diagnosis Related Groups | TRIS-DRG |
financial_aid_policy, general_contract_provisions, and billing_class are optional data elements. They are not required to be included, but instructions have been added to support standardization of disclosure of these data elements for hospitals that wish to provide more contextual information about their charges. If financial_aid_policy or general_contract_provisions is included in the MRF, we recommend it be included with the General Data Elements on the first row. If billing_class header is included in the MRF, we recommend it be included on the third row.
| Column Header (Tall format) | Column Header (Wide format) | Name | Type | Description | Blanks Accepted |
|---|---|---|---|---|---|
| financial_aid_policy | financial_aid_policy | Hospital Financial Aid Policy | String | The hospital’s financial aid policy. See additional financial aid policy notes for more details. | Yes |
| general_contract_provisions | general_contract_provisions | General Contract Provisions | String | Payer contract provisions that are negotiated at an aggregate level across items and services (e.g., claim level). | Yes |
| billing_class | billing_class | Billing Class | Enum | The type of billing for the item/service at the established standard charge. The valid values are "professional", "facility", and "both". | Yes |
The hospital’s financial aid policy, also known as charity care or bill forgiveness, that a hospital may choose or be required to apply to a particular individual’s bill. This information may be displayed as either a description or as a link to the financial aid or cash price policy on the hospital’s website.
This data element can be used to encode payer contract provisions that are applicable at an aggregate level and may include variable items and services. Examples could be "stop-loss" provisions or "lesser than" provisions that apply to the claim (as opposed to each item or service on the claim). Multiple general contract provisions across payer and plan combinations can be included in this data element. If a contract provision applies to a specific item or service, use the Payer-specific Negotiated Charge: Algorithm data element and encode the Estimated Allowed Amount data element.
The following conditional requirements must be met for an MRF to be considered valid. These conditional requirements enforce regulatory rules for required data elements, provide flexibility in the development of MRFs, and ensure corresponding information is encoded for items and services to be understandable by the end user.
- If a "payer specific negotiated charge" is encoded as a dollar amount, percentage, or algorithm then a corresponding valid value for the payer name, plan name, and standard charge methodology must also be encoded.
- If a standard charge is encoded, there must be a corresponding code and code type pairing. The code and code type pairing do not need to be in the first code and code type columns (i.e.,
code|1andcode|1|type). - If a value is encoded in the "code", a value must also be encoded in the corresponding "code type". Conversely, if a value is encoded in the "code type", a value must be encoded in the corresponding "code" (e.g., if a value is encoded in
code|2|type, then a value must be encoded incode|2). - If the "standard charge methodology" encoded value is "other", there must be a corresponding explanation found in the "additional notes" for the associated payer-specific negotiated charge.
- If an item or service is encoded, a corresponding valid value must be encoded for at least one of the following: "Gross Charge", "Discounted Cash Price", "Payer-Specific Negotiated Charge: Dollar Amount", "Payer-Specific Negotiated Charge: Percentage", "Payer-Specific Negotiated Charge: Algorithm".
- If there is a "payer specific negotiated charge" encoded as a dollar amount, there must be a corresponding valid value encoded for the deidentified minimum and deidentified maximum negotiated charge data.
- If a "payer specific negotiated charge" can only be expressed as a percentage or algorithm, then a corresponding "Estimated Allowed Amount" must also be encoded. Required beginning 1/1/2025.
- If code type is NDC, then the corresponding drug unit of measure and drug type of measure data element must be encoded. Required beginning 1/1/2025.
- If a modifier is encoded without an item or service, then a “Description” and one of the following is the minimum information required: “Payer-specific Negotiated Charge: Dollar Amount”, “Payer-specific Negotiated Charge: Percentage”, “Payer-specific Negotiated Charge: Algorithm”, “Additional Generic Notes”, or “Additional Payer-Specific Notes”. Required beginning 1/1/2025.
- If a value is encoded in the
drug_unit_of_measurement, a value must also be encoded in thedrug_type_of_measurement. Conversely, if a value is encoded in thedrug_type_of_measurement, a value must be encoded in thedrug_unit_of_measurement. Required beginning 1/1/2025.