SIMPRO table: what it is and how it works in practice

Medical and hospital supplies are one of the main sources of denials in complex hospital stays. A wrong code, an outdated description or an amount outside the contract: any of these failures results in a refusal by the payer.

The SIMPRO table is the pricing reference for materials used in contracts with payers in Brazil, and applying it correctly in billing is an essential part of managing the hospital revenue cycle.

What the SIMPRO table is

SIMPRO is a specialized database that brings together codes, technical descriptions and average prices for medical and hospital supplies, equipment, devices and inputs used in healthcare procedures. For each registered product, the table assigns a unique numeric code that identifies the item in a standardized way across the entire private healthcare market.

It is published every two months, in print and electronic formats. The bimonthly update keeps pace with new product launches, changes of manufacturer and price variations. Using an outdated version of SIMPRO in billing is a direct path to discrepancies with the payer.

The table is widely adopted in contracts between hospitals and payers as the pricing reference for materials. When the contract sets SIMPRO as the basis, the hospital must bill the materials used with the codes and amounts in the current edition, applying the markup percentages negotiated with each payer.

What SIMPRO covers

SIMPRO’s scope covers the main inputs used in hospital procedures, focusing on two large groups.

Medical and hospital supplies and disposables

This group includes items in everyday use in hospital stays and outpatient procedures: wound dressings, catheters, IV sets, syringes, sutures, drains and other disposables used in care. These are high-volume, low-unit-value products, but together they account for a significant share of any hospital’s materials billing.

Standardizing SIMPRO codes for these items is especially important because the volume of entries per claim is high. A coding error on a low-value item may seem insignificant on its own, but multiplied across hundreds of patient encounters it distorts monthly billing.

OPME: orthoses, prostheses and special materials

OPME is the most critical segment within SIMPRO. It covers implantable or single-use devices in high-complexity surgical procedures: orthopedic prostheses, stents, heart valves, spinal implants, among others. Anvisa (National Health Surveillance Agency) defines OPME as products intended to replace or complement structures of the human body, with a specific medical indication for each patient.

The unit value of an OPME item can range from a few thousand to tens of thousands of reais. In complex surgeries, the total cost of special materials often exceeds the physician fees and hospital daily rates combined. Any discrepancy in code, description or amount in this segment leads to a denial with a high financial impact and, often, a prolonged dispute with the payer.

That is why the billing and audit departments of higher-complexity hospitals treat correct OPME coding in SIMPRO as a priority.

How SIMPRO is used in hospital billing

SIMPRO comes into hospital operations at two moments: in contract negotiations with the payer and in the day-to-day execution of billing.

In the contract phase, the hospital and the payer set SIMPRO as the reference table for materials and establish the markup rate to be applied to the manufacturer price of each item. This rate varies by payer and by category of material, and must be stated explicitly in the contract. It is what sets the actual amount the hospital can bill above the listed price.

In billing execution, the process follows a direct sequence. After care is delivered, the billing specialist identifies each material used, finds the item in SIMPRO by its product code, checks the current amount in the most recent edition and applies the contractual markup rate. The resulting amount is entered on the billing form with the corresponding TUSS code and transmitted to the payer via the TISS standard, which defines the technical specifications for electronic communication between providers and payers.

Three practical points of attention for this routine:

• Current edition. SIMPRO is updated every two months. Billing must always use the edition in force on the date of care, not on the date the claim is submitted.

• Markup rate. The percentage applied to the manufacturer price varies by contract. Applying the wrong rate, whether from another health plan or from an earlier version of the contract, creates an amount discrepancy and a denial.

• Product without an approved code.Materials newly launched on the market may not yet be registered in SIMPRO. In these cases, billing requires specific handling with the payer before the claim is submitted, at the risk of automatic rejection.

SIMPRO and Brasíndice: complementary scopes

SIMPRO and Brasíndice are the two main pricing tables in the Brazilian hospital market. They cover different scopes and, in practice, are used together in any hospital stay that involves both medications and surgical materials.

Mixing up the two tables at billing time is an error that leads to an immediate denial: billing a medication with a SIMPRO code or a material with a Brasíndice code results in a domain table discrepancy that the payer rejects automatically.

In heart surgery, for example, the anesthetic drugs and antibiotics are billed based on Brasíndice, while the coronary stent and the surgical materials are billed based on SIMPRO.

An incorrect SIMPRO code leads to a denial

As with Brasíndice, incorrect use of SIMPRO in billing leads to an objective administrative denial: the payer identifies the discrepancy, rejects the item and the hospital loses the amount billed. In the OPME segment, where unit values are high, a single denial for an incorrect code can mean a significant loss.

The most frequent errors follow a recognizable pattern:

• Outdated code. The billing system is configured with an old edition of SIMPRO. The product was reclassified or had its code updated in the most recent edition, but the hospital keeps using the previous code. The payer rejects it for a code discrepancy.

• Product without an approved code.Newly launched materials not yet registered in SIMPRO are billed with the code of a similar product. The payer identifies the substitution and denies it for an incorrect code or lack of approval.

• Incorrect markup rate.The percentage applied to the manufacturer price does not match what is contracted with that payer. The difference between the amount billed and the amount expected leads to a financial denial, even if the product code is correct.

• Domain table confusion.A material is billed with a Brasíndice code instead of a SIMPRO code, or vice versa. The payer rejects it automatically for an incorrect domain table.

Prevention works on three fronts: automatic bimonthly SIMPRO updates in billing systems, correct configuration of markup rates by contract and early handling with the payer for materials without an approved code.

An up-to-date SIMPRO means protected billing

Hospital materials are billed by code. When the code is wrong, the payer does not deny in bad faith: it denies because what was sent does not match what was contracted. SIMPRO exists to eliminate that ambiguity, but it only plays that role when it is up to date, correctly configured and applied consistently across all contracts.

In hospitals with high surgical volume and multiple contracts, keeping SIMPRO synchronized manually is a task that depends on discipline, time and the absence of human error. If any one of these three elements fails, the denial shows up in the payer’s next audit.

Rivio automates this control within the hospital revenue cycle: the bimonthly SIMPRO update applied automatically by contract, markup rates configured by payer and discrepancies identified before the claim is submitted. The result is materials billing that reaches the payer without surprises, and revenue the hospital actually receives.

Frequently asked questions about the SIMPRO table

How often is the SIMPRO table updated?

SIMPRO is published every two months, in print and electronic formats. Billing must always use the edition in force on the date of care, not on the date the claim is submitted.

What is the difference between SIMPRO and Brasíndice?

SIMPRO covers medical and hospital supplies, equipment, devices and OPME. Brasíndice is the reference for medications registered with ANVISA. In complex hospital stays, the two tables are used together, each for its own scope. Billing an item with the wrong table leads to a denial for a domain table discrepancy.

What is OPME and why is SIMPRO essential for this segment?

OPME are the orthoses, prostheses and special materials used in high-complexity surgical procedures. The unit value of these items can reach tens of thousands of reais, which makes any coding error especially costly. SIMPRO is the main pricing reference for this segment in the private healthcare market.

Is SIMPRO an official government table?

SIMPRO is a private publication with no ties to government bodies. Its widespread adoption by the market comes from the consistency of its database and the regularity of its updates, not from a legal obligation. Its presence in contracts between hospitals and payers reflects an established market convention.

How does SIMPRO relate to the TISS standard?

The TISS standard, set by ANS (Brazil’s National Supplementary Health Agency), defines the technical specifications for exchanging information between providers and payers. Materials coded by SIMPRO are entered on billing forms with the corresponding TUSS code and transmitted to the payer via the TISS standard. SIMPRO provides the pricing reference; TISS defines the transmission format.