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Medicare Geographic Classification Review Board Ffy 2018 Decision Listing

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Medicare Geographic Classification Review Board Ffy 2018 Decision Listing MEDICARE GEOGRAPHIC CLASSIFICATION REVIEW BOARD FFY 2018 DECISION LISTING CASE PROVIDER FROM TO PROVIDER NAME STATUS NUMBER NUMBER MSA MSA 18C0001 52-0070 Mayo Clinic Health System - Eau Claire, Inc. Approved 20740 33460 18C0002 10-0022 Jackson Memorial Hospital Approved 33124 22744 18C0003 31-0032 Inspira Medical Center Vineland Approved 47220 12100 18C0004 24-0166 Mayo Clinic Health System - Fairmont Denied 24 31860 18C0005 44-0063 Johnson City Medical Center Approved 27740 11700 18C0006 26-0110 Southeast Hospital Denied 16020 16060 18C0006 26-0110 Southeast Hospital Denied 16020 41180 18C0007 46-0057 Park City Hospital Approved 46 41620 18C0008 39-0185 Lehigh Valley Hospital - Hazelton Approved 42540 10900 18C0009 31-0119 University Hospital Dismissed 18C0010 31-0031 Deborah Heart and Lung Center Denied 15804 35614 18C0011 38-0090 Bay Area Hospital Approved 38 21660 18C0012 17-0013 Hays Medical Center Approved 17 28 18C0013 37-0113 INTEGRIS Grove Hospital Approved 37 22220 18C0014 26-0186 Lake Regional Health System Approved 26 44180 18C0015 45-0465 Matagorda Regional Medical Center Approved 45 26420 18C0016 18-0043 Memorial Hospital Denied 18 30460 18C0017 34-0023 Park Ridge Health Approved 11700 24860 18C0018 52-0088 Saint Agnes Hospital Approved 22540 33340 18C0019 31-0002 Newark Beth Israel Medical Center Dismissed 18C0020 39-0133 Lehigh Valley Hospital Approved 10900 33874 18C0021 18-0005 Highlands Regional Medical Center Approved 18 26580 18C0022 39-0091 UPMC Northwest Medical Center Approved 39 38300 18C0024 34-0027 Lenoir Memorial Hospital, Inc. Approved 34 40580 18C0025 47-0001 Central Vermont Medical Center Approved 47 30 18C0026 15-0075 Bluffton Regional Medical Center Approved 23060 34620 18C0027 34-0024 Sampson Regional Medical Center Denied 34 48900 18C0028 36-0010 Union Hospital Association Approved 36 15940 18C0029 01-0005 Marshall Medical Center South Approved 01 13820 18C0030 07-0020 Middlesex Hospital Approved 25540 35300 18C0031 22-0073 Morton Hospital Approved 39300 14454 18C0032 51-0001 West Virginia University Hospitals, Inc. Approved 34060 38300 18C0033 25-0069 Rush Foundation Hospital Approved 25 46220 18C0034 25-0097 Southwest Mississippi Regional Medical Center Approved 25 12940 18C0035 39-0183 St. Luke's Miner's Memorial Hospital Approved 39 10900 18C0036 18-0048 Ephraim McDowell Regional Medical Center Approved 18 30460 18C0037 39-0048 Geisinger-Lewistown Hospital Approved 39 44300 18C0038 13-0018 Eastern Idaho Regional Medical Center Approved 26820 38540 18C0039 11-0125 Fairview Park Hospital Approved 11 31420 18C0040 15-0115 Memorial Hospital and Health Care Center Denied 15 21780 18C0041 18-0013 The Medical Center Denied 14540 34980 18C0042 44-0011 Blount Memorial Hospital Approved 28940 34 18C0043 11-0105 Colquitt Regional Medical Center Approved 11 45220 18C0044 17-0120 Labette Health Approved 17 27900 18C0045 37-0034 McAlester Regional Health Center Approved 37 46140 18C0046 18-0016 Jewish Hospital Shelbyville Denied 31140 30460 18C0047 01-0092 DCH Regional Medical Center Denied 46220 13820 18C0048 11-0150 Oconee Regional Medical Center Approved 11 12060 18C0049 11-0122 South Georgia Medical Center Approved 46660 45220 18C0050 11-0038 John D. Archbold Memorial Hospital Approved 11 45220 18C0051 01-0035 Cullman Regional Medical Center Approved 01 13820 18C0052 44-0059 Cookeville Regional Medical Center Approved 44 34980 18C0053 11-0002 Upson Regional Medical Center Approved 11 12060 18C0054 23-0030 MidMichigan Medical Center - Gratiot Approved 23 24340 18C0055 11-0001 Hamilton Medical Center Approved 19140 12060 18C0056 26-0006 Mosaic Life Care at St. Joseph Approved 41140 41140 18C0057 23-0037 Hillsdale Hospital Approved 23 11460 18C0058 05-0481 West Hills Hospital & Medical Center Approved 31084 37100 18C0059 01-0045 Fayette Medical Center Approved 01 13820 18C0060 39-0001 Geisinger - Community Medical Center Approved 42540 10900 Page 1 of 9 MEDICARE GEOGRAPHIC CLASSIFICATION REVIEW BOARD FFY 2018 DECISION LISTING CASE PROVIDER FORM FROM TO PROVIDER NAME NUMBER NUMBER NO. MSA MSA 18C0061 26-0074 Moberly Regional Medical Center Approved 26 17860 18C0062 10-0249 Seven Rivers Regional Medical Center Approved 26140 45300 18C0063 39-0237 Regional Hospital of Scranton Approved 42540 10900 18C0064 26-0034 Bates County Memorial Hospital Denied 28140 28140 18C0065 52-0177 Froedtert Memorial Lutheran Hospital Denied 33340 29404 18C0066 37-0056 Comanche County Memorial Hospital Denied 30020 36420 18C0067 24-0047 St. Luke's Hospital Approved 20260 33460 18C0068 32-0011 Presbyterian Espanola Hospital Approved 32 42140 18C0069 10-0023 Citrus Memorial Hospital Approved 26140 36100 18C0070 23-0075 Bronson Battle Creek Hospital Approved 12980 28020 18C0071 34-0131 CarolinaEast Medical Center Approved 35100 24780 18C0072 26-0050 SSM Health St. Francis Hospital Approved 26 41140 18C0073 29-0009 St. Mary's Regional Medical Center Approved 39900 05 18C0074 51-0050 Wheeling Hospital Approved 48540 38300 18C0075 26-0137 Freeman Health System Denied 27980 27900 18C0075 26-0137 Freeman Health System Denied 27980 22220 18C0076 07-0007 Lawrence + Memorial Hospital Approved 35980 35004 18C0077 26-0009 Bothwell Regional Health Center Approved 26 28140 18C0078 10-0062 Munroe Regional Medical Center Approved 36100 23540 18C0079 03-0119 Mercy Gilbert Medical Center Approved 38060 39140 18C0080 45-0044 UT Southwestern Medical Center Approved 19124 19124 18C0081 33-0164 Highland Hospital of Rochester Approved 40380 15380 18C0082 03-0036 Chandler Regional Medical Center Approved 38060 39140 18C0083 14-0067 Saint Francis Medical Center Approved 37900 14010 18C0084 33-0285 Strong Memorial Hospital Approved 40380 15380 18C0085 34-0141 New Hanover Regional Medical Center Approved 48900 48900 18C0086 05-0084 St Joseph's Medical Center Approved 44700 36084 18C0087 05-0058 Glendale Memorial Hospital & Health Center Approved 31084 37100 18C0088 03-0024 St. Joseph's Hospital & Medical Center Approved 38060 39140 18C0089 17-0068 Southwest Medical Center Approved 17 11100 18C0090 45-0080 Titus Regional Medical Center Denied 45 30980 18C0091 01-0078 Northeast Alabama Regional Medical Center Denied 11500 13820 18C0092 34-0050 Southeastern Regional Medical Center Approved 34 22180 18C0093 26-0025 Hannibal Regional Hospital Approved 26 41180 18C0094 03-0010 St. Mary's Hospital Approved 46060 38060 18C0095 42-0010 Carolina Pines Regional Medical Center Approved 22500 16740 18C0096 19-0164 Byrd Regional Hospital Approved 19 10780 18C0097 39-0079 Robert Packer Hospital Approved 39 13780 18C0098 44-0144 Tennova Healthcare - Harton Approved 44 34980 18C0099 10-0286 Physicians Regional Medical Center - Pine Ridge Approved 34940 15980 18C0100 36-0151 Affinity Medical Center Approved 15940 17460 18C0101 22-0035 North Shore Medical Center Approved 15764 14454 18C0102 15-0133 Kosciusko Community Hospital Approved 15 23060 18C0103 03-0114 Oro Valley Hospital Approved 46060 38060 18C0104 01-0040 Gadsden Regional Medical Center Approved 23460 13820 18C0105 05-0006 St. Joseph Hospital Approved 05 39820 18C0106 26-0175 Golden Valley Memorial Hospital Approved 26 28140 18C0107 36-0084 Aultman Hospital Approved 15940 17460 18C0108 52-0096 Wheaton Franciscan Healthcare - All Saints Denied 39540 29404 18C0109 52-0051 Columbia St. Mary's Hospital Milwaukee Denied 33340 29404 18C0110 05-0149 California Hospital Medical Center Approved 31084 37100 18C0111 17-0142 Via Christi Hospital Manhattan Approved 31740 45820 18C0112 36-0159 Adena Regional Medical Center Approved 36 18140 18C0113 03-0007 Verde Valley Medical Center Denied 39140 22380 18C0114 47-0024 Northwestern Medical Center, Inc. Approved 15540 15540 18C0115 38-0051 Salem Hospital Approved 41420 38900 18C0116 01-0150 L.V. Stabler Memorial Hospital Approved 01 33860 18C0117 26-0065 Mercy Hospital Springfield Denied 44180 41180 18C0117 26-0065 Mercy Hospital Springfield Denied 44180 28140 18C0118 01-0083 South Baldwin Regional Medical Center Approved 19300 37860 Page 2 of 9 MEDICARE GEOGRAPHIC CLASSIFICATION REVIEW BOARD FFY 2018 DECISION LISTING CASE PROVIDER FORM FROM TO PROVIDER NAME NUMBER NUMBER NO. MSA MSA 18C0119 26-0059 Mercy Hospital Lebanon Denied 26 41180 18C0119 26-0059 Mercy Hospital Lebanon Denied 26 44180 18C0120 36-0079 Kettering Medical Center Approved 19380 17140 18C0121 04-0118 NEA Baptist Memorial Hospital Denied 27860 32820 18C0122 33-0386 Catskill Regional Medical Center Approved 33 35084 18C0123 51-0024 Monongalia County General Hospital Approved 34060 38300 18C0124 39-0065 The Gettysburg Hospital Approved 23900 16540 18C0125 03-0011 St. Joseph's Hospital Approved 46060 38060 18C0126 10-0157 Lakeland Regional Medical Center Approved 29460 45300 18C0127 34-0028 Cape Fear Valley Medical Center Approved 22180 39580 18C0128 24-0071 District One Hospital Denied 24 33460 18C0129 37-0006 Alliance Health - Ponca City Approved 37 48620 18C0130 24-0088 Rice Memorial Hospital Approved 24 41060 18C0131 51-0071 Bluefield Regional Medical Center Approved 51 13980 18C0132 33-0222 Saratoga Hospital Approved 10580 47 18C0133 14-0040 Galesburg Cottage Hospital Approved 14 37900 18C0134 22-0077 Baystate Medical Center Approved 44140 49340 18C0135 39-0211 Sharon Regional Health System Denied 49660 17460 18C0136 26-0022 Northeast Regional Medical Center Approved 26 16 18C0137 16-0089 Ottumwa Regional Health Center Approved 16 26980 18C0138 32-0030 Artesia General Hospital Denied 32 36220 18C0139 04-0088 Medical Center South Arkansas Denied 04 33740 18C0140 45-0209 Northwest Texas Hospital Approved
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