Hospital Outpatient PPS
Guidance for Hospital Outpatient Prospective Payment System (PPS) rulemaking.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: October 03, 2019
OPPS & ASC: CY 2026 Proposed Rule – Submit Comments by September 15
CMS issued the CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule that proposes updates to Medicare payment policies and rates for hospital outpatient and ASC services.
See a summary of proposed provisions, including a request for information. Comments are due by September 15; see the proposed rule for details on how to submit them.
OPPS Drugs and Biologicals with Quarterly Restated Payment Rates
Some drugs and biologicals based on ASP methodology may have payment rates that are corrected retroactively. These retroactive corrections typically occur on a quarterly basis as a part of the OPPS payment system quarterly update change request. Beginning with the January 2015 OPPS payment system quarterly update change request, the list of drugs and biologicals with corrected payments rates, for a particular quarter, are accessible from the left menu link titled "Restated Drug and Biological Payment Rates".
Additional Resources
For questions on the Outpatient Prospective Payment System (OPPS), please contact to this mailbox (outpatientpps@cms.hhs.gov). For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) hospitals, go to the Hospital Center (see under "Related Links Inside CMS" below).
For files to order, see Limited Data Set Files - Hospital Outpatient Prospective Payment System and the Identifiable Data Files.
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.