Hospital Outpatient Prospective Payment System

HOPPS is used by CMS to reimburse for hospital outpatient services. CMS created HOPPS to reduce beneficiary co-payments in response to rapidly growing Medicare expenditures for outpatient services and large co-payments being made by Medicare beneficiaries.

All covered outpatient services belong to an Ambulatory Payment Classification group. Each group of procedure (i.e., codes) within an APC is supposed to be "similar clinically and with regard to resource consumption

Hospital Outpatient Prospective Payment System Rule


CMS released the 2017 MPFS Final Rule on November 2, 2016. We have prepared a detailed summary of the final rule as well as impact tables to show the specific change in reimbursement rates between 2016 and 2017 for each CPT code.

Summary of 2018 HOPPS: Final Rule | Proposed Rule

ACR Comment Letter on 2018 HOPPS Proposed Rule

Summary of 2017 HOPPS: Proposed Rule

ACR Comments to CMS on 2017 HOPPS Proposed Rule

 

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