Outpatient Prospective Payment Systems (OPPS)
CMS generally makes payment for hospital outpatient department services through the Hospital Outpatient Prospective Payment System (OPPS).
The Centers for Medicare & Medicaid Services (CMS) Oct. 31 issued a final rule that updates physician fee schedule (PFS) payments for calendar year (CY) 2026.
The AHA commented Sept. 15 on the Centers for Medicare & Medicaid Services calendar year 2026 outpatient prospective payment system and ambulatory surgical center payment system proposed rule.
RE: CMS–1832–P Medicare and Medicaid Programs; Calendar Year 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
CMS, in its outpatient prospective payment system proposed rule for calendar year 2026, proposes a net 2.4% increase in payment rates.
Below are three spreadsheets, one comparing relative weights and payment rates at the APC level, using the 2026 proposed rule Addendum A compared to 2025 Addendum A (July 1, 2025 file), as downloaded from the CMS website.
The AHA is disappointed that CMS proposes an inadequate Medicare outpatient hospital payment update, as many hospitals — especially those in rural and underserved communities — operate under challenging financial pressures.
The AHA is disappointed that CMS proposes an inadequate Medicare outpatient hospital payment update as many hospitals — especially those in rural and underserved communities — operate under challenging financial pressures.
Facility fees are the portion of a health care treatment bill that covers all the costs of delivering patient care, except for those that are billed by physicians and other professionals.
Three HPA OPPS Rate Comparison Tables for 2025.
The Centers for Medicare & Medicaid Services (CMS) Nov. 1 released its calendar year (CY) 2025 outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) final rule. The rule increases OPPS rates by a net 2.9% in CY 2025 compared to CY 2024.