Critical Access Hospital and Sole Community Hospital Outpatient Rate Add-ons
EFFECTIVE 4/1/2024 - 3/31/2025
- Add-ons also available in Portable Document Format (PDF)
| Critical Access Hospital Rate Add-ons (4/1/2024 - 3/31/2025) | Clinic | Ambulatory Surgery | Emergency Department | |||
|---|---|---|---|---|---|---|
| Operating Certificate | Medicaid ID | NPI | Hospital Name | Add-on Payment Per Visit | Add-on Payment Per Visit | Add-on Payment Per Visit |
| 2238700 | 00310852 | 1013128941 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 03000635 | 1053497388 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 03000644 | 1073724530 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 03000653 | 1124238332 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 03000662 | 1104234376 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 03000671 | 1366653826 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 03000680 | 1467663344 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 03000699 | 1518178409 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 03000704 | 1528279817 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 03000713 | 1578774451 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 03000722 | 1598976052 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 03000731 | 1710176458 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 03000740 | 1720299654 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 03000759 | 1801007364 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 03000768 | 1982815445 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 03000777 | 1992916456 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 05448673 | 1124535604 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 05797833 | 1881926533 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 05797842 | 1184128563 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 05797911 | 1750944310 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 06358772 | 1891104717 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 06916792 | 1154193233 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 06916807 | 1871365072 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 06916861 | 1962274043 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 06916870 | 1801668983 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 2238700 | 06916889 | 1528830742 | Carthage Area Hospital | $401.00 | $2,195.00 | $372.00 |
| 4458701 | 02994847 | 1235184649 | Clifton-Fine Hospital | $401.00 | $2,195.00 | $372.00 |
| 4720700 | 00302429 | 1689741985 | Cobleskill Regional Hospital | $401.00 | $2,195.00 | $372.00 |
| 4720700 | 03000488 | 1891862579 | Cobleskill Regional Hospital | $401.00 | $2,195.00 | $372.00 |
| 2625700 | 00354229 | 1932100393 | Community Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 2625700 | 03001567 | 1992707608 | Community Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 0226700 | 00354238 | 1407839822 | Cuba Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 0226700 | 03196283 | 1770738791 | Cuba Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 1229700 | 00347571 | 1417940719 | Delaware Valley Hospital | $401.00 | $2,195.00 | $372.00 |
| 5526700 | 02094860 | 1073525341 | Ellenville Regional Hospital | $401.00 | $2,195.00 | $372.00 |
| 5263700 | 02961773 | 1649251554 | Garnet Health Medical Center - Catskills - Grover M. Hermann | $401.00 | $2,195.00 | $372.00 |
| 5263700 | 05702043 | 1740442870 | Garnet Health Medical Center - Catskills - Grover M. Hermann | $401.00 | $2,195.00 | $372.00 |
| 4423701 | 00354256 | 1023449709 | Gouverneur Hospital | $401.00 | $2,195.00 | $372.00 |
| 4423701 | 03001576 | 1629409925 | Gouverneur Hospital | $401.00 | $2,195.00 | $372.00 |
| 2424700 | 00354370 | 1518380732 | Lewis County Health System | $401.00 | $2,195.00 | $372.00 |
| 2424700 | 03001627 | 1619390838 | Lewis County Health System | $401.00 | $2,195.00 | $372.00 |
| 2424700 | 05814397 | 1427565126 | Lewis County Health System | $401.00 | $2,195.00 | $372.00 |
| 2424700 | 06765764 | 1235749979 | Lewis County Health System | $401.00 | $2,195.00 | $372.00 |
| 2424700 | 06894971 | 1518532548 | Lewis County Health System | $401.00 | $2,195.00 | $372.00 |
| 2129700 | 00310870 | 1548220908 | Little Falls Hospital | $401.00 | $2,195.00 | $372.00 |
| 2129700 | 03000786 | 1558321919 | Little Falls Hospital | $401.00 | $2,195.00 | $372.00 |
| 2129700 | 05831723 | 1174009112 | Little Falls Hospital | $401.00 | $2,195.00 | $372.00 |
| 2129700 | 05954774 | 1093362931 | Little Falls Hospital | $401.00 | $2,195.00 | $372.00 |
| 2129700 | 05954783 | 1104473990 | Little Falls Hospital | $401.00 | $2,195.00 | $372.00 |
| 2129700 | 05954792 | 1912554791 | Little Falls Hospital | $401.00 | $2,195.00 | $372.00 |
| 2129700 | 06085496 | 1205483005 | Little Falls Hospital | $401.00 | $2,195.00 | $372.00 |
| 1226701 | 00279387 | 1164473039 | Margaretville Hospital | $401.00 | $2,195.00 | $372.00 |
| 1226701 | 03000451 | 1740233840 | Margaretville Hospital | $401.00 | $2,195.00 | $372.00 |
| 1226701 | 03000460 | 1912950643 | Margaretville Hospital | $401.00 | $2,195.00 | $372.00 |
| 4402701 | 00354398 | 1871659391 | Massena Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 4402701 | 03001636 | 1972604460 | Massena Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 3622700 | 00310898 | 1366573131 | Medina Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 3622700 | 03000819 | 1437280955 | Medina Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 3622700 | 03000828 | 1467583989 | Medina Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 3622700 | 03000837 | 1558492074 | Medina Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 3622700 | 03000846 | 1609873520 | Medina Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 3622700 | 03000855 | 1679641864 | Medina Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 3622700 | 03527635 | 1508119884 | Medina Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 3622700 | 07822237 | 1023149549 | Medina Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 1254700 | 00354081 | 1447311030 | O'Connor Hospital | $401.00 | $2,195.00 | $372.00 |
| 1254700 | 03001530 | 1801975156 | O'Connor Hospital | $401.00 | $2,195.00 | $372.00 |
| 1254700 | 03001549 | 1891728192 | O'Connor Hospital | $401.00 | $2,195.00 | $372.00 |
| 2221700 | 02392854 | 1003814641 | River Hospital | $401.00 | $2,195.00 | $372.00 |
| 2221700 | 03011387 | 1821022781 | River Hospital | $401.00 | $2,195.00 | $372.00 |
| 4823700 | 00363144 | 1639150477 | Schuyler Hospital, Inc. | $401.00 | $2,195.00 | $372.00 |
| 4823700 | 03002522 | 1740364181 | Schuyler Hospital, Inc. | $401.00 | $2,195.00 | $372.00 |
| 4823700 | 03335471 | 1760582142 | Schuyler Hospital, Inc. | $401.00 | $2,195.00 | $372.00 |
| 4823700 | 07116847 | 1902430689 | Schuyler Hospital, Inc. | $401.00 | $2,195.00 | $372.00 |
| 4823700 | 07116856 | 1417580697 | Schuyler Hospital, Inc. | $401.00 | $2,195.00 | $372.00 |
| 6120700 | 02994705 | 1215044516 | Soldiers and Sailors Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 6120700 | 02984430 | 1285777086 | Soldiers and Sailors Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 6120700 | 02984449 | 1093858896 | Soldiers and Sailors Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 6120700 | 06417963 | 1538708128 | Soldiers and Sailors Memorial Hospital | $401.00 | $2,195.00 | $372.00 |
| 1624700 | 00354114 | 1114954682 | University of Vermont Health Network - Alice Hyde | $401.00 | $2,195.00 | $372.00 |
| 1624700 | 03001558 | 1578627865 | University of Vermont Health Network - Alice Hyde | $401.00 | $2,195.00 | $372.00 |
| 1552701 | 00354274 | 1407061591 | University of Vermont Health Network - Elizabethtown Comm. Hosp | $401.00 | $2,195.00 | $372.00 |
| 1552701 | 03001585 | 1891785184 | University of Vermont Health Network - Elizabethtown Comm. Hosp | $401.00 | $2,195.00 | $372.00 |
| 6027000 | 00310889 | 1316924913 | Wyoming County Community Hospital | $401.00 | $2,195.00 | $372.00 |
| 6027000 | 03000795 | 1437136843 | Wyoming County Community Hospital | $401.00 | $2,195.00 | $372.00 |
| 6027000 | 03000800 | 1639156045 | Wyoming County Community Hospital | $401.00 | $2,195.00 | $372.00 |
| Sole Community Hospital Rate Add-ons (4/1/2024 - 3/31/2025) | Clinic | Ambulatory Surgery |
Emergency Department |
|||
|---|---|---|---|---|---|---|
| Operating Certificate |
Medicaid ID | NPI | Hospital Name | Add-on Payment Per Visit |
Add-on Payment Per Visit |
Add-on Payment Per Visit |
| 1623001 | 00363213 | 1245446533 | Adirondack Medical Center | $125.00 | $2,924.00 | $162.00 |
| 1623001 | 03002559 | 1699709576 | Adirondack Medical Center | $125.00 | $2,924.00 | $162.00 |
| 1623001 | 03002568 | 1750395562 | Adirondack Medical Center | $125.00 | $2,924.00 | $162.00 |
| 1623001 | 03002577 | 1740317189 | Adirondack Medical Center | $125.00 | $2,924.00 | $162.00 |
| 1623001 | 03002586 | 1831226273 | Adirondack Medical Center | $125.00 | $2,924.00 | $162.00 |
| 1623001 | 03002595 | 1922135367 | Adirondack Medical Center | $125.00 | $2,924.00 | $162.00 |
| 1623001 | 03474128 | 1922135367 | Adirondack Medical Center | $125.00 | $2,924.00 | $162.00 |
| 0501000 | 00347553 | 1093712911 | Auburn Community Hosp | $125.00 | $2,924.00 | $162.00 |
| 0501000 | 03001223 | 1205801362 | Auburn Community Hosp | $125.00 | $2,924.00 | $162.00 |
| 0501000 | 07599580 | 1336855683 | Auburn Community Hosp | $125.00 | $2,924.00 | $162.00 |
| 3801000 | 00279098 | 1114114808 | A.O. Fox Hospital | $125.00 | $2,924.00 | $162.00 |
| 3801000 | 03000415 | 1578529954 | A.O. Fox Hospital | $125.00 | $2,924.00 | $162.00 |
| 0601000 | 00381439 | 1215917224 | Brooks-TLC Hospital System | $125.00 | $2,924.00 | $162.00 |
| 0601000 | 02995848 | 1487738886 | Brooks-TLC Hospital System | $125.00 | $2,924.00 | $162.00 |
| 0601000 | 03002999 | 1609846948 | Brooks-TLC Hospital System | $125.00 | $2,924.00 | $162.00 |
| 0601000 | 03924825 | 1538419502 | Brooks-TLC Hospital System | $125.00 | $2,924.00 | $162.00 |
| 0601000 | 06501284 | 1225654494 | Brooks-TLC Hospital System | $125.00 | $2,924.00 | $162.00 |
| 4429000 | 00354196 | 1568548782 | Canton-Potsdam Hospital | $125.00 | $2,924.00 | $162.00 |
| 4429000 | 03131160 | 1114104445 | Canton-Potsdam Hospital | $125.00 | $2,924.00 | $162.00 |
| 5401001 | 00332729 | 1144397100 | Cayuga Medical Center at Ithaca | $125.00 | $2,924.00 | $162.00 |
| 5401001 | 03001067 | 1164547303 | Cayuga Medical Center at Ithaca | $125.00 | $2,924.00 | $162.00 |
| 5401001 | 03001076 | 1366519795 | Cayuga Medical Center at Ithaca | $125.00 | $2,924.00 | $162.00 |
| 5401001 | 03001085 | 1962422733 | Cayuga Medical Center at Ithaca | $125.00 | $2,924.00 | $162.00 |
| 5401001 | 03001094 | 1982771325 | Cayuga Medical Center at Ithaca | $125.00 | $2,924.00 | $162.00 |
| 0824000 | 00314723 | 1770593956 | Chenango Memorial Hospital | $125.00 | $2,924.00 | $162.00 |
| 4401000 | 02997831 | 1891753034 | Claxton-Hepburn Medical Center | $125.00 | $2,924.00 | $162.00 |
| 4401000 | 02966865 | 1346301389 | Claxton-Hepburn Medical Center | $125.00 | $2,924.00 | $162.00 |
| 4401000 | 02966874 | 1396805073 | Claxton-Hepburn Medical Center | $125.00 | $2,924.00 | $162.00 |
| 4401000 | 02966883 | 1861552549 | Claxton-Hepburn Medical Center | $125.00 | $2,924.00 | $162.00 |
| 4401000 | 02966989 | 1427119486 | Claxton-Hepburn Medical Center | $125.00 | $2,924.00 | $162.00 |
| 4401000 | 07014579 | 1447843636 | Claxton-Hepburn Medical Center | $125.00 | $2,924.00 | $162.00 |
| 5263000 | 02997051 | 1710977012 | Garnet Health Medical Center - Catskills | $125.00 | $2,924.00 | $162.00 |
| 5263000 | 02978536 | 1205096278 | Garnet Health Medical Center - Catskills | $125.00 | $2,924.00 | $162.00 |
| 1101000 | 00279176 | 1033117635 | Guthrie Cortland Medical Center | $125.00 | $2,924.00 | $162.00 |
| 1101000 | 03000424 | 1396743993 | Guthrie Cortland Medical Center | $125.00 | $2,924.00 | $162.00 |
| 1101000 | 03000433 | 1487655056 | Guthrie Cortland Medical Center | $125.00 | $2,924.00 | $162.00 |
| 1101000 | 03000442 | 1740287531 | Guthrie Cortland Medical Center | $125.00 | $2,924.00 | $162.00 |
| 0228000 | 00354403 | 1720030703 | Jones Memorial Hospital | $125.00 | $2,924.00 | $162.00 |
| 0228000 | 06582636 | 1477176667 | Jones Memorial Hospital | $125.00 | $2,924.00 | $162.00 |
| 0228000 | 06582645 | 1376166652 | Jones Memorial Hospital | $125.00 | $2,924.00 | $162.00 |
| 0228000 | 06582654 | 1457974644 | Jones Memorial Hospital | $125.00 | $2,924.00 | $162.00 |
| 0228000 | 06582663 | 1467075622 | Jones Memorial Hospital | $125.00 | $2,924.00 | $162.00 |
| 0228000 | 06582672 | 1376166538 | Jones Memorial Hospital | $125.00 | $2,924.00 | $162.00 |
| 3824000 | 00305000 | 1063572733 | Mary Imogene Bassett Hospital | $125.00 | $2,924.00 | $162.00 |
| 3824000 | 03000584 | 1093897910 | Mary Imogene Bassett Hospital | $125.00 | $2,924.00 | $162.00 |
| 3824000 | 03000593 | 1780600577 | Mary Imogene Bassett Hospital | $125.00 | $2,924.00 | $162.00 |
| 3824000 | 03000608 | 1851452890 | Mary Imogene Bassett Hospital | $125.00 | $2,924.00 | $162.00 |
| 3824000 | 06428528 | 1700198652 | Mary Imogene Bassett Hospital | $125.00 | $2,924.00 | $162.00 |
| 0401001 | 00354632 | 1225083074 | Olean General Hospital | $125.00 | $2,924.00 | $162.00 |
| 0401001 | 03001778 | 1699715904 | Olean General Hospital | $125.00 | $2,924.00 | $162.00 |
| 0401001 | 03001787 | 1700825262 | Olean General Hospital | $125.00 | $2,924.00 | $162.00 |
| 0401001 | 03001796 | 1740333681 | Olean General Hospital | $125.00 | $2,924.00 | $162.00 |
| 3702000 | 02997771 | 1871678458 | Oswego Health | $125.00 | $2,924.00 | $162.00 |
| 2201000 | 00354316 | 1093722068 | Samaritan Medical Center | $125.00 | $2,924.00 | $162.00 |
| 2201000 | 03001594 | 1598713745 | Samaritan Medical Center | $125.00 | $2,924.00 | $162.00 |
| 2201000 | 03001609 | 1801902713 | Samaritan Medical Center | $125.00 | $2,924.00 | $162.00 |
| 5002001 | 00363162 | 1013985399 | St. James Hospital | $125.00 | $2,924.00 | $162.00 |
| 5002001 | 03002531 | 1104893320 | St. James Hospital | $125.00 | $2,924.00 | $162.00 |
| 5002001 | 03002540 | 1699742270 | St. James Hospital | $125.00 | $2,924.00 | $162.00 |
| 0901001 | 00318814 | 1033270699 | Univ of Vt Hlth Network-Champlain Valley Physicians | $125.00 | $2,924.00 | $162.00 |
| 0901001 | 03000873 | 1376607531 | Univ of Vt Hlth Network-Champlain Valley Physicians | $125.00 | $2,924.00 | $162.00 |
| 0901001 | 03000882 | 1487785382 | Univ of Vt Hlth Network-Champlain Valley Physicians | $125.00 | $2,924.00 | $162.00 |
| 0901001 | 03000891 | 1609942739 | Univ of Vt Hlth Network-Champlain Valley Physicians | $125.00 | $2,924.00 | $162.00 |
| 0901001 | 03000906 | 1841344983 | Univ of Vt Hlth Network-Champlain Valley Physicians | $125.00 | $2,924.00 | $162.00 |
