Standard Charge File and Guest Estimates
Effective January 1, 2019, in an effort to “improve the transparency of hospital charges”, the Center for Medicare and Medicaid Services (CMS) has mandated that all facilities participating in the Medicare and Medicaid programs “make public a list of their standard charges” via the internet [CMS-1694-F]. Further, Santa Clara Valley Medical Center (SCVMC) is happy to provide our Estimator Tool to allow individuals to calculate an estimate of potential charges and patient liability for the most common 300 shoppable services as required by CMS and the President’s Executive Order.
The County of Santa Clara Health System (CSCHS) gladly supports this effort and is therefore providing this information to our patients by posting our price file for both facility and professional charges for our SCVMC campus on this site.
In addition, in compliance with CMS Outpatient Prospective Payment System Policy [CMS-1717-F2, Doc Citation 84 FR 65524], we have provided a machine-readable file which includes the following information regarding services provided at SCVMC:
- Total charges for services provided at SCVMC;
- Discounted cash (self-pay) prices;
- De-identified minimum and maximum negotiated rates; and
- Payer-specific negotiated rates.
STANDARD CHARGE FILE
Santa Clara Valley Medical Center Standard Charge File
Santa Clara Valley Medical Center Guest Estimator link
This tool provides an estimate of potential charges ONLY, based upon the information the user has provided, on the date that the estimate was created. It is not intended as a comprehensive list of charges or a final liability or payment agreement between Santa Clara Valley Medical Center (SCVMC) and the account guarantor.
When services are provided there may be additional charges for supplies, medications, and other clinical services as ordered by the guest’s physician. VMC reserves the right to modify these charges in accordance with organizational policies.
This estimate does not represent a guarantee of these prices for services on the date services are rendered.
The total charges listed by the Estimator Tool, for a procedure or encounter, may not necessarily represent the total payment expected by SCVMC. The expected payment amount may vary based upon updated contractual arrangements between SCVMC and the various payors, the insurance plans in which the guest is enrolled, and other special programs for which the guest may apply and be found eligible for.
The estimate provided by the Estimator Tool does not constitute a contract and does not obligate our guest(s) to receive the items or services from SCVMC or any other provider.
Please note: The estimate of potential charges generated by the Estimator Tool is not the same as the Good Faith Estimate required under the No Surprises Act. For more information about the Good Faith Estimate required under the No Surprises Act, please visit our “No Surprises Act” page.
Should a guest have questions regarding their bill or require financial assistance or advice, they are encouraged to contact a Financial Counselor at (866) 967-4677 for direction.
The Price File, also known as the Charge Description Master (CDM), consists of two master lists of charges related to all services, including professional fees, supplies, devices, vaccines, radiopharmaceuticals, and room accommodation charge codes for inpatients and outpatients of Santa Clara Valley Medical Center (SCVMC). There are currently two Price Files in use at SCVMC.
- The Hospital Billing (HB) Price File contains the facility related charges.
- The Professional Billing (PB) Price File contains the professional service-related charges.
Together, these two Price Files constitute the Charge Description Master (CDM) at Santa Clara Valley Medical Center.
The Price File contains the following elements:
- Procedure Master Number – A unique identifier within the system for each chargeable item.
- Procedure Record Name – A brief description of the service.
- CPT© (Current Procedural Terminology) or HCPCS (Healthcare Common Procedure Coding System) code – This is a nationally recognized alphanumeric code utilized by the insurance industry and government payors to identify a particular service or item.
- Unit Charge – The gross dollar amount charged for each item to the account.
Variable prices may be present for services such as Reference Lab testing, implanted devices and items/services governed by other contracted rates. These prices may not be available for listing in the CDM since billed charges are based upon the charges as invoiced by the contractor to SCVMC at the time the service is provided.
Pharmaceutical prices listed are acquisition cost based. These costs may vary depending upon many factors such as date purchased and supplier. The patient may therefore see multiple prices for what appears to be the same medication. In practice, depending upon the dosage ordered by the provider, a patient may see multiple units of a single medication listed on a claim. The total of these units represents the total dosage provided to the patient. Due to these variances, we recommend that our patients contact the SCVMC Pharmacy department directly for the most accurate estimate based upon the provider’s medication orders.
Pricing in the SCVMC Price File is updated on July 1st of each year. Prices listed will correspond with prices as established by resolution of the Board of Supervisors of the County of Santa Clara for the current fiscal year. SCVMC reserves the right to modify these charges in accordance with organizational policies.
TOP 50 DRGS
For your information, we have also provided a list of average total charges for our Top 50 DRGs (Diagnosis Related Groups).
Santa Clara Valley Medical Center Top 50 DRGs
Individual departments within Santa Clara Valley Medical Center (SCVMC) may generate charges through an electronic charge or order communication system. Most charging information for a patient admission or encounter originates from the CDM. The charges, charge descriptions, and all codes attached to a line item in the CDM, flow through electronic systems to Patient Business Services (PBS), where corresponding claims are generated. The claims may be edited before submission to the appropriate payors based upon contractual terms.
The total charges listed for a particular encounter or admission may not necessarily represent the total payment expected by SCVMC. The expected payment amount will vary based upon contractual arrangements between SCVMC and the various payors, the insurance plan in which the patient is enrolled and other special programs for which the patient may apply and be found eligible for.
CPT© Codes 2021 American Medical Association, use of this site denotes acceptance of below terms and conditions
CPT© codes, descriptions, and material only are copyright 2021 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT© . AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. CPT© is a trademark of the American Medical Association.
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