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) 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
Comparison of Proposed 2025 OPPS Addendum B With July 2024 Addendum B.
Congress is considering legislation that would change current billing practices for Medicare and the commercial insurance market to require each off-campus hospital outpatient department (HOPD) to be assigned a unique NPI as a condition of payment.
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. CMS…
The Centers for Medicare & Medicaid Services July 10 issued a proposed rule that would increase Medicare hospital outpatient prospective payment system rates by a net 2.6% in calendar year 2025 compared to 2024. This includes a proposed 3.0% market basket update, offset by a 0.4 percentage…
CMS has yet again proposed an inadequate update to hospital payments. This proposed increase for outpatient hospital services of only 2.6% comes despite the fact that many hospitals across the country continue to operate on negative or very thin margins that make providing care and investing in…
As urged by the AHA, the Centers for Medicare & Medicaid Services Feb. 6 corrected an error in the outpatient prospective payment system final rule for calendar year 2024 that reduced by over 40% reimbursement for hyperbaric oxygen therapy, a critical treatment option in advanced wound care.
AHA shares comments and ask that commissioners consider the following issues before making their final payment update recommendations at the upcoming Medicare Payment Advisory Commission (MedPAC) meeting.