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 Nov. 21 released its calendar year 2026 outpatient prospective payment system and ambulatory surgical center final rule. The rule increases OPPS rates by a net 2.6% in CY 2026 compared to CY 2025.
The AHA is disappointed that CMS has finalized cuts to hospital and health system services, including those in rural and underserved communities. Combined with its continued inadequate market basket updates, the agency is exacerbating the challenging financial pressures under which hospitals are…
The Centers for Medicare & Medicaid Services Nov. 21 issued a final rule that, among other provisions, increases Medicare hospital outpatient prospective payment system rates by a net 2.6% in calendar year 2026 compared to 2025.
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.