Outpatient PPS

Hospital Outpatient, Ambulatory Surgical Center Proposed Rule for CY 2024

July 28, 2023

The Centers for Medicare & Medicaid Services (CMS) July 13 released its calendar year (CY) 2024 outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) proposed rule that would increase OPPS rates by a net 2.8% in CY 2024 compared to CY 2023. The rule also includes proposals related to hospital price transparency requirements, behavioral health services and Rural Emergency Hospitals (REHs). The final rule will be published on or around Nov. 1 and take effect Jan. 1, 2024. CMS will accept comments on the proposed rule through Sept. 11.

Key Highlights

CMS’ proposed rule would:

  • Increase Medicare hospital OPPS rates by a net 2.8% in CY 2024 compared to CY 2023.
  • Create standardized formats for hospital price transparency files, including new required data elements such as contracting type for negotiated rates, and establish additional CMS monitoring and enforcement mechanisms.
  • Expand access to behavioral health services, including new coverage for intensive outpatient programs for behavioral health conditions.
  • Pay for 340B acquired drugs and biologicals at the average sales price (ASP) plus 6% and, effective Jan. 1, 2025, require that all 340B hospitals only report the “TB” modifier.
  • Add 10 services to the inpatient-only list.
  • Adopt new measures for the Outpatient, ASC and REH Quality Reporting Programs and modify several others.
  • Seek comments on a potential payment mechanism for hospitals to establish and maintain access to a buffer supply of essential medicines.


The AHA is deeply concerned that CMS is proposing a CY 2024 outpatient hospital payment update of only 2.8% despite persistent financial headwinds facing the hospital field. Most hospitals across the country continue to operate on negative or very thin margins that make providing care and investing in their workforce very challenging day to day. Without a more robust payment update in the final rule, hospitals’ and health systems’ ability to continue caring for patients and providing essential services for their communities may be jeopardized.

Separately, hospitals remain committed to helping patients access the information they need when planning for their care, including meaningful information about the cost of that care. The AHA will be carefully reviewing the proposed changes to the Hospital Price Transparency Rule to ensure they continue to advance our shared objective with CMS of making it easier for patients to access pricing and cost information while reducing unnecessary administrative burden and costs on hospitals and health systems.

What You Can Do

  • Participate in an AHA members-only webinar on Friday, Aug. 18 at 2 p.m. ET to share your questions and feedback on this regulation for AHA’s comment letter to CMS. To register for this 90-minute webinar, visit here.
  • Share this advisory with your senior management team and ask your chief financial officer to examine the impact of the proposed payment changes on your Medicare revenue for CY 2024. Spreadsheets comparing the proposed changes in the APC payment rates and weights from 2023 to 2024 are available on the AHA’s OPPS webpage. To access these, you must be logged on to the website.
  • Share this advisory with your billing, medical records, quality improvement and compliance departments, as well as your clinical leadership team to apprise them of the proposals around the ambulatory payment classifications (APCs), mental health services, hospital price transparency and quality measurement requirements.
  • Submit comments to CMS with your specific concerns by Sept. 11 at www.regulations.gov.

Download the Regulatory Advisory

Site-Neutral Payment

However, these roles are not explicitly funded; instead, they are built into the overall hospital cost structure and supported by revenues received from providing direct patient care. Hospitals are also subject to more comprehensive licensing, accreditation and regulatory requirements t...