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.
Outpatient Prospective Payment Systems (OPPS)
CMS generally makes payment for hospital outpatient department services through the Hospital Outpatient Prospective Payment System (OPPS).
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.
Medicare's sustained and substantial underpayment of hospitals has stretched for almost two decades, and today's final outpatient rule only worsens this chronic problem. The agency's final increase of less than 3% for outpatient hospital services will make the provision of care, investments in the…
The Centers for Medicare & Medicaid Services Nov. 1 issued a final rule that increases Medicare hospital outpatient prospective payment system rates by a net 2.9% in calendar year 2025 compared to 2024.
AHA urges CMS to consider whether adjustments are necessary in its approach to annual market basket updates to ensure that beneficiaries continue to have access to high-quality outpatient care. We also urge CMS to eliminate the productivity cut for CY 2025, as detailed below.
The CY 2025 Outpatient PPS/ASC Payment System Proposed Rule slide deck from August 6, 2024, AHA webinar.
The Centers for Medicare & Medicaid Services (CMS) July 10 released its calendar year (CY) 2025 outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) proposed rule. The rule would increase OPPS rates by a net 2.6% in CY 2025 compared to CY 2024.
Lookup Tool: The third spreadsheet is an OPPS APC/HCPCS lookup tool that allows the user to pull-up basic descriptive and payment information for a code.
2025 NPRM Addendum A Compared to July 2024 Addendum A