TOTCHG_X retains the total charge supplied by a data source, including cents and negative values, with the following exceptions:

• Zero charges are set to missing (.); and
• Charges that round to zero are set to missing (.).

TOTCHG_X has the same value as TOTCHG just before edit checks on total charges are performed. TOTCHG contains the cleaned total charges. TOTCHG_X contains the original value of total charges.

Generally, total charges (TOTCHG and TOTCHG_X) do not include professional fees and non-covered charges. If the source provides total charges with professional fees, then the professional fees are removed from the charge during HCUP processing. In a small number of HCUP databases, professional fees can not be removed from total charges because the data source cannot provide the information. Please check the state-specific notes for information on which states are affected.

In some cases, only copay amounts, such as $10 or $20, may be in the total charges. There is no documentation as to the prevalence of this practice.

Beginning in 1996, Arizona included charges for professional fees and patient convenience items in its total charges. Any charges for professional fees and convenience items were subtracted from the reported total charges during HCUP processing to make Arizona total charges (TOTCHG and TOTCHG_X) comparable to data from other states.

Due to an error in HCUP processing in 1996, some types of professional fees were not subtracted from total charges (TOTCHG and TOTCHG_X). The types of professional fees that were not subtracted include hospital visits, consultations, private duty nurses, EKGs, EEGs, and medical social services. Charges for these services were coded on 24% of the 1996 discharges, with a mean charge of $216 and a range from $1 to $5,718. Total charges (TOTCHG and TOTCHG_X) can be corrected by subtracting the detail charge, CHG61. No other years need correction.

Beginning in 1997, all reported professional fees and patient convenience items were subtracted from total charges (TOTCHG and TOTCHG_X).

California supplied total charges only for the last 365 days of the stay for stays of more than one year (365 days). If the supplied length of stay was greater than 365 days,

• cleaned total charges, TOTCHG, was set to missing (.) and
• uncleaned total charges, TOTCHG_X, retained the supplied total charge.

Prior to 2022, some hospitals in California (including all Kaiser and Shriner hospitals) were exempted from reporting total charges. For those hospitals, TOTCHG and TOTCHG_X were missing (.).

Source documentation indicated that hospital-based physician fees were not included in the reported total charges.

No Charges

The source reported total charges with the value of 1 for discharges with no charges ($0). These records include live donors and courtesy or research patients. Values of 1 were verified with the hospital by the source.

Prior to 1995, total charges were set to missing (TOTCHG and TOTCHG_X = .) for these records during HCUP processing. Beginning in 1995, only TOTCHG was set to missing (.) [invalid (.A) for 2008-2012 data] and TOTCHG_X retained the value of 1.

According to Colorado, hospital based physician fees are excluded from total charges (TOTCHG and TOTCHG_X).

For data years 2019-2021, total charges were set to missing for several hospitals due to substantially high mean total charges compared to previous years. TOTCHG_X retains the original values.

Connecticut includes non-covered charges in the total charges if they are reported by hospitals but, does not report non-covered charges separately. The HCUP uniform total charges (TOTCHG_X) could not be adjusted to exclude non-covered charges. (Non-covered charges include items such as telephone and television).

Due to an error in HCUP processing, a few zero charges occur in the Illinois 1990-1991 HCUP Illinois files. Input values of zero were set to missing (.) before TOTCHG was rounded. If the input charge was between $0.01 and $0.49, then the rounded TOTCHG is 0.

Beginning in 1993, Iowa includes professional fees in its total charges if the hospital combines hospital and professional bills. From 1993 to 2002, professional fees were subtracted from total charges (TOTCHG and TOTCHG_X) during HCUP processing to make Iowa total charges comparable to data from other states. Due to an error in processing the inpatient data in 2003-2004, professional fees were NOT subtracted from the total charges. Users can correct this by subtracting non-covered charges (CHG16) and professional fees (CHG17) from the total charges (TOTCHG and TOTCHG_X). Beginning in 2005, professional fees and non-covered items are excluded from the total charges (TOTCHG and TOTCHG_X).

Prior to 1993, it was optional for hospitals to report total charges to the hospital association:

• The availability of total charges varies by hospital.
• Some hospitals have missing (.) total charges (TOTCHG and TOTCHG_X) on a large percentage of records.

It was optional for hospitals to provide total charges to the hospital association. Approximately 5% to 25% of the discharges are missing total charges.

Some hospitals report total charges of $1.00 for all discharges. For 1993-1994, the $1.00 charges are included in the HCUP data. Beginning with 1995, total charges of $1.00 in the Kansas inpatient data were set to missing (.).

Some smaller hospitals have data systems that allow a maximum of 5 digits for total charges. For these hospitals, total charges of $100,000 or greater are coded as $99,999.

For data year 2019, the sum of the detail charges (REVCHGn) do not equal the total charges (TOTCHG) for over half of the discharge records.

Beginning in 2007, Maryland included the records from all other outpatients, Greenbaum cancer center, and UMMS shock trauma in the unified AS and ED outpatient data file. Total changes associated with some of these new records were smaller than $100. During the HCUP processing, these values were categorized in “Inconsistent”, which resulted in increasing the frequency associated with it.

Beginning in 2006, Maryland stopped providing total charges. This data element is created based on charges associated with revenue code 0001 during the HCUP data processing.

Maryland excluded the following from total charges:

• Physician charges and
• Charges not regulated by the Health Services Cost Review Commission (for example, telephone service, television charges or private duty nursing charges).

Total charges in the 2008 Maryland SID are not rounded to the nearest dollar.

Beginning in 2006, Maryland stopped providing total charges. This data element is created based on charges associated with revenue code 0001 during the HCUP data processing.

Maryland excluded the following from total charges:

• Physician charges and
• Charges not regulated by the Health Services Cost Review Commission (for example, telephone service, television charges or private duty nursing charges).

Massachusetts included professional fees in its detailed and total charges, if these were included by the hospital. Hospitals are allowed, though not required, to report these professional fees in the charge fields. Individual facilities decide which professional fees are included and where. There is no way to determine which hospitals did or did not include professional fees.

Special consideration was needed to handle the Massachusetts data beginning in the 2006 NIS. Fourth quarter data from sampled hospitals in Massachusetts were unavailable for inclusion in the 2006 and 2007 NIS. To account for the missing quarter of data, we sampled one fourth of the Massachusetts NIS discharges from the first three quarters and modified the records to represent the fourth quarter. To ensure a representative sample, we sorted the Massachusetts NIS discharges by hospital, discharge quarter, Clinical Classifications Software (CCS) diagnosis group for the principal diagnosis, gender, age, and a random number before selecting every fourth record. The following describes the adjustments made to the selected Massachusetts NIS records:

1. We relabeled the discharge quarter (DQTR) to four and saved the original discharge quarter in a new data element (DQTR_X).
2. We adjusted the admission month (AMONTH) by the number of months corresponding to the change in the discharge quarter.
3. We adjusted the total charges (TOTCHG and TOTCHG_X) using quarter-specific adjustment factors calculated as the mean total charges in the fourth quarter for all Northeastern NIS states (excluding Massachusetts) divided by the mean total charges in the first, second, or third quarter for all Northeastern NIS states (excluding Massachusetts).

Michigan provides Total Charges beginning in 2001.

In 2006, four Michigan hospitals submitted TOTCHG_X with implied decimals. The problem begins in March for one hospital and in July for the other three facilities. During processing we fixed the problem data for both TOTCHG_X and TOTCHG.

According to the Missouri Hospital Association, most hospitals excluded professional fees from total charges (TOTCHG and TOTCHG_X).

Prior to 2007, the total charges for Nevada are the charges reported for UB-92 revenue center "0001". Fewer than 1% of discharges include professional fees (revenue codes, 096x, 097x and 098x) in the total charge field. Beginning in 2007, the total charges were the charges reported for UB-04 revenue center "0001".

The original New Mexico inpatient file contained outpatient records from HOSPID=35020. During the creation of the 2011 New Mexico SID these outpatient records, identified by a length of stay of 0 days, were excluded. This approach also eliminated any inpatient discharges with same day stays for this hospital. Any analysis using the 2011 New Mexico SID should be aware that this hospital is missing information on same day stays.

For the 1988-1993 HCUP files, New York supplied their Master File which consists of Discharge Data Abstracts (DDA) matched to Uniform Billing Forms (UBF) for inpatient stays. Information on total charges is included in the UBF part of the record. Due to an administrative change in the collection of billing records for 1989, a large percentage of the DDAs could not be matched to a UBF. When there was no match, charge information is missing. The match rate improves over time and stabilizes after 1991. The percentage of DDA records that have a matching UBF record in the Master File is as follows:

Beginning in the 1994 data, hospitals submitted discharge records to New York in a new format, using Universal Data Set (UDS) specifications. This format combines the old UBF and DDA data into a single submission record.

Adjustment to Charges for Interim Bills

• For 1988-1993, when the length of stay from the Discharge Data Abstract did not equal the length of the billing period from the Uniform Billing Form, total charges (TOTCHG) were set to missing (.) because this billing information pertained only to the billing period, not the complete inpatient stay. However, TOTCHG_X contains the original value from the billing record.
• Beginning in 1994, billing dates were not reported by New York and the adjustment to charge details (CHGn, RATEn, UNITn, REVCDn) was not made.

Ohio excludes the following charges:

• Total charges < $100
• Total charges > $1,000,000
• Total charges = 0

Kaiser hospitals are exempt from reporting total charges. As a result, TOTCHG and TOTCHG_X are missing (.) for Kaiser Hospitals in Oregon.

Beginning in the 1995 data, some hospitals did not report total charges (TOTCHG and TOTCHG_X) on charity bills since there are no charges to the patient.

Prior to 1997, non-covered charges and professional charges were subtracted from the supplied total charge during HCUP processing to make Pennsylvania total charges (TOTCHG_X) comparable to data from other states.

Beginning in 1997, Pennsylvania supplied total charges that did not include non-covered and professional charges.

Charges for patient convenience items were subtracted from the reported total charges during HCUP processing to make Rhode Island total charges (TOTCHG and TOTCHG_X) comparable to data from other states.

Beginning in 1996, professional fees and charges for patient convenience items were subtracted from the reported total charges during HCUP processing to make South Carolina total charges (TOTCHG and TOTCHG_X) comparable to data from other states.

Prior to 1996, only professional fees were subtracted from the reported total charges because the source did not supply an itemized charge for patient convenience items.

In 2006, total charges were not included on South Carolina SASD or SEDD because of a problem with a major data vendor in the state.

Prior to 1998 data, negative total charges were erroneously set to invalid (.A). Beginning in 1998, negative total charges are retained in TOTCHG_X and set to inconsistent (.C) in TOTCHG.

In 2019, the total charges for hospital DSHOSPID 974820 were calculated incorrectly. Studies using the total charges for this hospital should multiply the reported amount by 100 for the correct amount.

Beginning in 2006, charges associated with the professional fees and non-covered items (revenue code centers 096X, 097X, 098X, and 099X) have been removed from total charges.

Total charges are not available in the Texas data until July 2000. Non-covered accommodation and ancillary charges were subtracted from the supplied total charge during HCUP processing to make Texas total charges (TOTCHG_X) comparable to data from other states.

Beginning in 2002, professional fees were subtracted from the reported total charges during HCUP processing to make Utah total charges (TOTCHG and TOTCHG_X) comparable to data from other states. Utah indicates that for the majority of the discharges, the reported total charge includes professional fees. Utah reports the total charge for the UB-92 revenue code "001" if the hospital provides individual revenue codes to the data organization; otherwise the total charge is the hospital-reported total. For the hospitals that do not provide individual revenue codes, Utah does not have any means of determining whether or not professional charges are included. Prior to 2002, professional fees were not subtracted from the total charges (TOTCHG and TOTCHG_X). To make the total charges comparable to data from other states, professional fees (CHG2) should be subtracted from total charges (TOTCHG and TOTCHG_X).

Beginning in 2006, Virginia reports total charges under revenue center code 0001. If this code is present, the corresponding charge is retained to TOTCHG. If a revenue center code 0001 is not reported or contains a missing or known invalid value, TOTCHG is missing. The maximum value allowed for total charges in the Virginia source files is $9,999,999.

Incorrect Charge Information in 2001 for Three Virginia Hospitals. Please set TOTCHG and TOTCHG_X to missing in 2001 for the following three Virginia hospitals:

• DSHOSPID=490071
• DSHOSPID=490112
• DSHOSPID=490118.

The data source reported incorrect charges for these hospitals.

West Virginia has rate setting. The data source confirms that the all covered charges are included in the total charge (TOTCHG_X).

Prior to 2006, Wisconsin may have included professional fees and convenience items in its total charges. Hospitals are instructed to remove these fees from total charges, but some hospitals do not subtract them and others have had difficulties with their accounting software. There is no way to determine which hospitals did or did not include these items.

Hospitals are not required to report total charges for stays over 100 days.

An error during HCUP processing of 1993 discharges caused negative values of total charges (TOTCHG_X) to be set to missing (.) instead of retained as reported by the data source. For other years, negative values of TOTCHG_X were processed correctly.