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Specifically, we are finalizing with modification revisions to 45 CFR 180.20 to add definitions for tenth (10th) percentile allowed amount, median allowed amount, and ninetieth (90th) percentile allowed amount, which are values a hospital will encode when a payer-specific negotiated charge is based on a percentage or algorithm, to more accurately reflect the distribution of actual amounts that a hospital has received for an item or service

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Commenters contended that the current methodology may be appropriate for lower cost APCs where the differences between the APC levels ( and procedures are less significant

Many commercial plans explicitly exclude weight management medications from their formulary