Skip to main content

Enrollment in the Health Benefits for Immigrant Adults (HBIA) program will be temporarily paused effective July 1, 2023.

Expensive Drugs and Devices for Hospitals and ASTCs

A hospital or ambulatory surgical treatment center (ASTC) is eligible for additional payment consideration termed an "outlier payment" for specified expensive drugs and devices provided in conjunction with a procedure from the Ambulatory Procedures Listing (APL). These drugs and devices, along with the associated APL codes, are identified in the table below. The table also identifies the drugs and devices that require prior approval.

Outpatient Cost Outlier Worksheet

The Outpatient Cost Outlier Worksheet below can be used to calculate the amount of the additional outlier payment.