Site-Neutral Payments

A woman and man sitting next to each other; he holds a TV remote control, she is looking at a bill.

The origins of Medicare's different payment systems and proposals for developing so-called site-neutral payments are explored in this brief.

Medicare uses more than a dozen different payment systems to set payment rates for the medical items and services the program covers for beneficiaries. The location where a beneficiary receives a service determines which payment system applies. Each system has its own methodology for rate-setting reflecting costs of operating the setting and the different patient populations served in each.

However, these methodologies rarely account for the amount Medicare might pay for the same service provided in a different clinical setting. As a result, services that can be provided in a variety of clinical settings may sometimes be paid for at dramatically different payment rates.

Recently, the Centers for Medicare and Medicaid Services (CMS) and the Medicare Payment Advisory Commission (MedPAC) have been exploring options to eliminate this differential payment for certain services. This brief explains the origins of these differential payments and the debate over approaches that have been proposed for developing so-called site-neutral payments.


Policy Briefs


Implementing the Medi­care Access and CHIP Reauthorization Act (MACRA)

March 27, 2017

A policy brief from Health Affairs and RWJF addresses the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), signed into law by President Obama in April 2015, with the initial phase of the law having begun on Jan. 1, 2017.


Medicaid and Permanent Supportive Housing

October 14, 2016

The ACA gave states tools to use in serving the state's homeless adults. Housing is one of the social and economic factors that play a critical role in determining an individual's health.


Telehealth Parity Laws

August 15, 2016

This Health Affairs health policy brief discusses the ongoing reforms expanding the landscape of telehealth in the health care system, as well as the challenges that remain.

Media Contacts

Sue Ducat

Health Affairs (301) 841-9962

Additional Media Contact: Melissa Blair

Robert Wood Johnson Foundation (609) 627-5937