Steps for Making Public Hospital Standard Charges in a Machine-Readable Format
Using a Required CMS Template Layout
Updat
ed March 15, 2024
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This document addresses the requirementtive for hospitals to conform to a CMS
ationctio
matio required by 45 CFR 180.50.
The hospital price transparency requirements are codified in regulation at 45 C.F.R. Part 180 and
require most hospitals to make public their standard charges (as defined at § 180.20) online in two
ways:
1. A comprehensive machine-readable file that includes the following standard charges for all
hospital items and services (as provided in § 180.50): gross charges, discounted cash prices,
payer-specific negotiated charges, and de-identified minimum and maximum negotiated
charges; and
2. A consumer-friendly display that includes the following standard charges for at least 300
‘shoppable’ services (or as many as the hospital provides if less than 300) that are grouped with
charges for ancillary services that are customarily provided by the hospital (as provided in §
180.60): discounted cash prices, payer-specific negotiated charges, and de-identified minimum
and maximum negotiated charges.
This document describes how to create a comprehensive machine-readable file using a CMS template
layout. For information about the consumer-friendly display of shoppable services, refer to the 10
Steps to a Consumer-Friendly Display of Shoppable Services document.
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Step 1: Identify your hospital and each hospital location that must make available its
list of standard charges
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• Verify your institution meets the definition of “hospital”. The HPT regulations define
“hospital” to mean an institution in any State in which State or applicable local law provides for
the licensing of hospitals, that is licensed as a hospital pursuant to such law or is approved, by
the agency of such State or locality responsible for licensing hospitals, as meeting the standards
established for such licensing. For purposes of this definition, a State includes each of the
several States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa,
and the Northern Mariana Islands. If your institution meets this definition, your institution is
subject to the statutory requirement.
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-making-public-standard-charges-shoppable-services.pdf
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§ 180.50(a)(2)
Steps for Making Public Hospital Standard Charges in a Machine-Readable Format
Using a Required CMS Template Layout
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• Check to see if your hospital is excepted. Certain hospitals are deemed by CMS to be in
compliance with the requirements including the following:
(1) Federally owned hospital facilities, including facilities operated by the U.S. Department
of Veterans Affairs and Military Treatment Facilities operated by the U.S. Department of
Defense.
(2) Hospitals operated by an Indian Health Program as defined in section 4(12) of the Indian
Health Care Improvement Act.
(3) State forensic hospitals that provide treatment exclusively to individuals who are in the
custody of penal authorities.
If your hospital is excepted, stop. Your hospital is not required to make public your standard
charges in the form and manner required at 45 CFR 180.50 or 180.60.
• Identify each hospital location that operates under your hospital’s license, including each off-
campus location. Under the regulations, 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.
Your hospital may post a single file of standard charges for a single campus location if the file includes
charges for all items and services offered at the single campus location. In cases where off-campus and
affiliated sites operate under the same license (or approval) as a main location but have different
standard charges or offer different items and services, these locations would separately make public
the standard charges for such locations.
Step 2: Identify each standard charge your hospital has established and its
corresponding item or service
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In the comprehensive machine-readable file, you must include all the standard charges your hospital
has established for all corresponding items and services provided by your hospital.
Identify all standard charges established by your hospital. You must make public in the machine-
readable file for each of the items and services, as applicable, the following standard charges (as
defined at 45 CFR 180.20) your hospital has established in both inpatient and outpatient settings:
• Gross charge: This is the charge for an individual item or service that is reflected on your
hospital's chargemaster, absent any discounts.
3
§180.50(a)(1)
Steps for Making Public Hospital Standard Charges in a Machine-Readable Format
Using a Required CMS Template Layout
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• Payer-specific negotiated charge: This is the charge that your hospital has negotiated with a
third-party payer for an item or service or service package. Each payer-specific charge in your
machine-readable file must be clearly associated with the name of the third-party payer and
plan.
o Hospitals can consult their rate sheets or rate tables within which the payer-specific
negotiated charges are often found. Such rate sheets typically contain a list of common
billing codes for items and services provided by the hospital along with the associated
payer-specific negotiated charge or rate (84 FR 65559).
o If you do not have a rate sheet, consult your payer contract to determine the algorithm
used to establish your payer-specific negotiated charge for an item or service or service
package.
• De-identified minimum negotiated charge: The lowest charge that a hospital has negotiated
with all third-party payers for an item or service.
• De-identified maximum negotiated charge: The highest charge that a hospital has negotiated
with all third-party payers for an item or service.
• Discounted cash price: The charge that applies to an individual who pays cash (or cash
equivalent) for a hospital item or service.
Your hospital is not required to make public Medicare and Medicaid fee-for-service (FFS)
reimbursement rates because such data is publicly available. However, nothing in Hospital Price
Transparency Final Rule limits your hospital’s ability to include this information if you choose (84 FR
65558).
Understand the definition of hospital “items and services”. Items and services as defined at § 180.20
means all items and services, including individual items and services and service packages, that could
be provided by a hospital to a patient in connection with an inpatient admission or an outpatient
department visit for which the hospital has established a standard charge. Examples of hospital items
and services include supplies and procedures, room and board, use of the facility and other items
(generally described as facility fees), services of employed physicians and non-physician practitioners
(generally reflected as professional charges), and any other items or services for which a hospital has
established a standard charge.
Your hospital may have established standard charges for items and services that are time-based or unit-
based or have a service package that has been negotiated with a third-party payer to include treatment
for complications or follow up care. These are included in the definition of hospital items and services.
Steps for Making Public Hospital Standard Charges in a Machine-Readable Format
Using a Required CMS Template Layout
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On the CMS Hospital Price Transparency - Data Dictionary GitHub repository, we have provided
-based services, unit-based charges
and service packages.
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Step 3: Select a Required CMS Template
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your hospital must adopt a CMS template layout and encode data elements
according to the technical specifications described in the CMS Hospital Price Transparency Data
Dictionary.
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The CMS template layouts and corresponding data dictionary are located on the CMS Hospital Price
Transparency GitHub repository. This repository houses the required CMS templates, in a CSV “tall”,
hospitals must encode standard charge information into MRFs.
Select one layouts. We recommend you
directly download and use a CSV template from the GitHub repository because it is pre-populated with
some information which can help you avoid some encoding errors.
Step 4: Gather and Encode your Standard Charge Information in the CMS Template
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your hospital must encode, in its machine-readable file, all standard charge
information, as applicable, for each of the following required data elements:
General data elements, including:
• Hospital name, license number, and location name(s) and address(es) under the single hospital
license to which the list of standard charges applies. Location name(s) and address(es) must
include, at minimum, all inpatient facilities and stand-alone emergency departments; and
• The version number of the CMS template and the date of most recent update to the standard
charge information in the machine-readable file.
Each type of standard charge as defined at § 180.20 (gross charge, discounted cash price, payer-
specific negotiated charge, de-identified minimum negotiated charge, and de-identified maximum
negotiated charge) and, for payer-specific negotiated charges, the following additional data elements:
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-price-
5
§ 180.50(c)(2)
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-price-transparency
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§ 180.50(b)
Steps for Making Public Hospital Standard Charges in a Machine-Readable Format
Using a Required CMS Template Layout
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• Payer and plan names; plan(s) may be indicated as categories (such as “all PPO plans”) when
the established payer-specific negotiated charges are applicable to each plan offered by a
specific payer, in the indicated category;
• Method used to establish the standard charge; and
• Whether the standard charge indicated should be interpreted by the user as a dollar amount,
or if the standard charge is based on a percentage or algorithm. If the standard charge is based
on a percentage or algorithm, the machine-readable file (MRF) must also describe the
percentage or algorithm that determines the dollar amount for the item or service. In addition,
a hospital must calculate and encode an estimated allowed amount
in dollars for an item or service when the hospital has established a payer-specific negotiated
charge that can only be expressed as a percentage or an algorithm (88 FR 82100).
A description of the item or service that corresponds to the standard charge established by the
hospital, including:
• A general description of the item or service;
• Whether the item or service is provided in connection with an inpatient admission or an
outpatient department visit; and
•
Coding information, including:
• Any code(s) used by the hospital for purposes of accounting or billing for the item or service;
• Corresponding code type(s). Such code types may include, but are not limited to, the CPT code,
the HCPCS code, the DRG, the NDC, Revenue Center Codes (RCC), or other common payer
identifier; and
•
corresponds to a hospital item or service, including a description of the modifier and how it
changes the standard charge.
Navigate to the data dictionary, located on GitHub, for detailed technical specifications on how to
encode your data in your selected CMS template.
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-price-transparency
Steps for Making Public Hospital Standard Charges in a Machine-Readable Format
Using a Required CMS Template Layout
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Step 5: Affirm the accuracy and completeness of your file
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Your hospital must make a good faith effort to ensure that the standard charge information encoded in
the MRF is true, accurate, and complete as of the date indicated in the MRF.
In the MRF template, you must affirm, to the best of your knowledge and belief, that your hospital has
included all applicable standard charge information in its MRF, in accordance with the requirements of
§ § 180.
50, and that the information encoded is true, accurate, and complete as of the date indicated
in the MRF.
Information for encoding the affirmation statement for CSV
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formats can be found on the
CMS Hospital Price Transparency GitHub. If you have downloaded a CSV template from the GitHub
repository, the affirmation statement has been included for you. Encode “true” as a valid value to
make the affirmation.
Step 6: Name your machine-readable file according to the CMS naming convention
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Your hospital must use the following naming convention when saving your comprehensive machine-
readable file: <ein>_<hospitalname>_standardcharges.[json|csv].
• <ein>: Your Hospital’s Employer Identification Number
• <hospital-name>: Name of Your Hospital
• <standard charges>: “standardcharges”
• [json|csv]: Your chosen file format.
We recommend you use the machine-readable file naming wizard that CMS has developed to assist you
as your name your file.
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Step 7: Validate that you have encoded your data correctly within the CMS Template
In addition to providing the data dictionaries and templates, to further aid hospitals we have developed
an MRF validation tool,
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which can be used by your hospital as an initial check for compliance with the
formatting requirements of § 180.50(c).
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§ 180.50(a)(3)(ii)
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-price-entation
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-price-entation
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§ 180.50(d)(5)
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Steps for Making Public Hospital Standard Charges in a Machine-Readable Format
Using a Required CMS Template Layout
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Use the MRF validation tool which is available on the Hospital Price Transparency Tools page here:
Hospital Price Transparency - Tools (cmsgov.github.io). You should correct any errors identified by the
validation tool using the technical instruction specified in CMS Hospital Price Transparency Data
Dictionary GitHub repository here: GitHub - -price-transparency. There is no limit to
the number of times you can run your file through the validator and we recommend you utilize this tool
until your file returns error free.
Step 8: Post your machine-readable file prominently on a publicly available website
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You must post your hospital’s machine-readable file of all items and services on a publicly available
website. The standard charge information must be displayed in a prominent manner and must be
clearly identified with the hospital location with which the standard charges are associated. Ensure that
the standard charge information is easily accessible, without barriers, including but not limited to
ensuring the information is accessible:
• Free of charge;
• Without having to establish a user account or password;
• Without having to submit personal identifying information (PII); and
• To automated searches and direct file downloads through a link posted on a publicly available
website.
Specific examples of barriers to automated searches and direct downloads that CMS identified include,
but are not limited to, lack of a link for downloading a single machine-readable file, using ‘‘blocking
codes’’ or CAPTCHA, and requiring the user to agreement to terms and conditions or submit other
information prior to access.
Step 9: Add the TXT file and Footer link
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nsure that the public website your hospital selects to host its
machine-readable file establishes and maintains, in the form and manner specified by CMS:
1) A .txt file in the root folder that includes:
o The hospital location name that corresponds to the machine-readable file;
o The source page URL that hosts the machine-readable file;
o A direct link to the machine-readable file (the machine-readable file URL); and
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§ 180.50(d)
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§ 180.50(d)(6)
Steps for Making Public Hospital Standard Charges in a Machine-Readable Format
Using a Required CMS Template Layout
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o
Hospital point of contact information.
2) A link in the footer on your website, including but not limited to the homepage, that is labeled
“Price Transparency” and links directly to the publicly available web page that hosts the link to
the machine-readable file.
Navigate to the GitHub Tools repository and use the TXT file generator tool on the Hospital Price
Transparency Tools GitHub to create your TXT file.
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Refer to TXT FAQs if you have additional questions
about this step, or you can email your question to PriceTransparencyHospitalCharges@cms.hhs.gov.
Step 10: Update your hospital’s MRF annually
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Your hospital must update its standard charge information in its comprehensive machine-readable file
at least once annually. Please ensure your file reflects the most recent date your MRF was updated as
defined in Data Dictionary found on the GitHub repository.
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--
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§ 180.50(e)
For additional resources for making public standard charges in a machine-readable format using
a required CMS Template Layout, please see the:
Hospital Price Transparency – tiontation
examples, and discussion posts.
The TXT and Policy FAQs on the CMS HPT Resources page.
The Hospital Price Transparency Tools site, where you can:
• Access requirements and technical specifications for the TXT file, as well as find example
TXT files.
• Use the TXT file generator tool to create the required TXT file.
• Use the MRF file naming tool to create a compliant naming convention for an MRF.
• Use the Online Validator 2.0 to check that the MRF complies with the CMS template layout
and data encoding requirements.
