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Updates of Addendum A and B are posted quarterly to the OPPS website. These addenda are a "snapshot" of HCPCS codes and their status indicators, APC groups, and OPPS payment rates, that are in effect at the beginning of each quarter.
- Hospital Outpatient Regulations and Notices
Medicare Coverage Center; End Stage Renal Disease (ESRD)...
- Restated Drug and Biological Payment Rates
Restated Drug and Biological Payment Rates - Addendum A and...
- Annual Policy Files
Annual Policy Files - Addendum A and Addendum B Updates |...
- APC
OPPS New Technology APC Only applications submitted through...
- Archives
This page contains the device and procedure edits for...
- April 2008
April 2008 - Addendum A and Addendum B Updates | CMS -...
- July 2023
July 2023 - Addendum A and Addendum B Updates | CMS -...
- October 2007
October 2007 - Addendum A and Addendum B Updates | CMS -...
- Hospital Outpatient Regulations and Notices
Under current policy, the applicable payment rate for products receiving drug pass-through payment is generally average sales price (ASP) plus 6 percent minus the portion of the APC payment amount that CMS determines is associated with the drug or biological.
One of the biggest changes for 2024 is the Ambulatory Payment Classification (APC) reassignment of total shoulder arthroplasty (CPT® code 23472) from APC 5115 to APC 5116, resulting in a 36.2% payment increase ($17,775; +$4,727) compared to CY 2023.
On Thursday, November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 Hospital Outpatient Prospective Payment System (HOPPS) 1 final rule, which includes payment cuts for radiation therapy services effective January 1, 2024.
The 2024 OPPS final rule increases reimbursement under the Medicare program by 3.1% for hospitals that meet quality reporting requirements.
7 lis 2023 · Base payments for items and services furnished in hospital outpatient settings and ASCs will increase by 3.1% after factoring in the usual 0.2-percentage-point “productivity” reduction. The update will drop by 2 percentage points for hospitals that fail to meet quality-reporting requirements.
1 lis 2022 · The CY 2023 OPPS/ASC final rule updates Medicare payment rates for partial hospitalization program (PHP) services furnished in hospital outpatient departments and community mental health centers (CMHCs).
