Search results
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
Hospital Outpatient Regulations and Notices - Addendum A and...
- Restated Drug and Biological Payment Rates
Change Request Restated Drug and Biological Payment Rates....
- Annual Policy Files
This list contains OPPS files that were created as program...
- 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
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.
2 lis 2023 · For CY 2024, CMS is finalizing Medicare payment rates under the OPPS for over 240 dental codes to align with the dental payment provisions in the CY 2023 Physician Fee Schedule final rule by assigning them to clinical APCs.
CMS issued the CY 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule to update Medicare OPPS and ASC. See a summary of provisions effective January 1, 2025. On June 15, 2022, the Supreme Court held in American Hospital Association v.
CMS will increase the payment rates under the OPPS by an Outpatient Department (OPD) fee schedule increase factor of 3.1%. This increase is based on the hospital inpatient market basket percentage increase of 3.3% for inpatient services paid under the hospital inpatient prospective payment system (IPPS), minus
For 2024, CMS is updating the 2023 OPPS payment rates for hospitals that meet quality reporting requirements by 3.1%. This update is based on the projected hospital market basket increase of 3.3% which was reduced by 0.2 percentage points for the productivity
25 lis 2024 · And starting in January, the Medicare reimbursement rate for physicians will go down again by nearly 3% on average, the Centers for Medicare & Medicaid Services reported in its annual fee adjustment.