CIP.002.194

Definition	The additional payment on a claim that is associated with either a cost outlier or length of stay outlier. Outlier payments compensate hospitals paid on a fixed amount per Medicare "diagnosis related group" discharge with extra dollars for patient stays that substantially exceed the typical requirements for patient stays in the same DRG category.
Size	S9(11)V99
FLF Start Position	1124
FLF Stop Position	1136
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be between -99999999999.99 and 99999999999.99 2. Value must be expressed as a number with 2-digit precision (e.g. 100.50) 3. Value must be populated when Outlier Code (CIP.002.197) is in [01,02,10] 4. Conditional

RULE ID	RULE Definition
RULE-708	If a claim line is a non-denied claim line from an LT file, then the drug outlier amount value reported must be compatible with specified T-MSIS picture format: S9(11)V999.
RULE-709	If a non-denied IP claim and has an outlier value of day outlier, cost outlier or composite of cost outliers, then the DRG outlier amount must be populated.
RULE-710	If a claim is a non-denied claim from an IP file, and the outlier code is equal to '00' or '09', then the DRG outlier amount must be 0 or null.

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CIP.002.194	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be populated when Outlier Code (CIP.002.197) is in [01,02,10]4. Conditional
07/12/2023	3.10.0	CIP.002.194	UPDATE	Coding requirement	Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'4. Conditional
07/12/2023	3.10.0	CIP.002.194	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be populated, if Outlier Code (CIP.002.197) equals '00' or '09'4. Conditional	Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'4. Conditional
07/12/2023	3.10.0	CIP.002.194	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must not be populated, if Outlier Code (CIP.002.197) equals '00' or '09'4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be populated, if Outlier Code (CIP.002.197) equals '00' or '09'4. Conditional
07/14/2023	3.10.0	CIP194	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT\| CIP194\|DRG-OUTLIER-AMT\|Value must not be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'\|	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT\| CIP194\|DRG-OUTLIER-AMT\|Value must be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'\|
06/24/2022	3.0.0	DRG-OUTLIER-AMT	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| CODING REQUIREMENT CIP194 \|DRG-OUTLIER-AMT\|The additional payment on a claim that is associated with either a cost outlier or length of stay outlier.Outlier payments compensate hospitals paid on a fixed amount per Medicare "diagnosis related group" discharge with extra dollars for patient stays that substantially exceed the typical requirements for patient stays in the same DRG category. \|1.(GS) value must satisfy the requirements of US Dollar Amount (DT) 2.(N) conditional 3.(FD1) value must not be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'	\|DE No\|Data Element Name\|Definition\| CODING REQUIREMENT CIP194 \|DRG-OUTLIER-AMT\|The additional payment on a claim that is associated with either a cost outlier or length of stay outlier.Outlier payments compensate hospitals paid on a fixed amount per Medicare "diagnosis related group" discharge with extra dollars for patient stays that substantially exceed the typical requirements for patient stays in the same DRG category \|1.(GS) value must satisfy the requirements of US Dollar Amount (DT) 2.(FD1) value must not be populated, if Outlier Code (CIP.002.197) equals '00' or '09' 3.(N) conditional
08/05/2022	3.0.1	CIP194	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT CIP194\|DRG-OUTLIER-AMT\|Value must not be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT CIP194\|DRG-OUTLIER-AMT\|Value must be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'

DRG-OUTLIER-AMT