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To ensure that the estimated CY 2026 aggregate outlier payments would equal 1.0 percent of estimated aggregate total payments under the OPPS, we proposed that the hospital outlier threshold be set so that outlier payments would be triggered when a hospital's cost of furnishing a service exceeds 1.75 times the APC payment amount and exceeds the APC payment amount plus the fixed-dollar threshold

For patients at our Doral clinic who present with injuries across more than one joint or muscle group, this systemic reach is a key reason TB-500 is selected over a localized peptide alone

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The measure does not have exclusions beyond observation stays for numerator component (3) and (4) because the numerator events included in the measure are considered access failures regardless of patient complexity or surge scenarios