Hospital Outpatient Prospective Payment System

The Hospital Outpatient Prospective Payment System (HOPPS) is used by CMS to reimburse for hospital outpatient services. The CMS created HOPPS to reduce beneficiary copayments in response to rapidly growing Medicare expenditures for outpatient services and large copayments being made by Medicare beneficiaries.

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

Background


Below we provide several background documents on HOPPS

Hospital Outpatient Prospective Payment System Rule


CMS released the Calendar Year (CY) 2018 HOPPS Final Rule on November 1, 2017. Below we provide detailed summaries of past Proposed and Final Rules, along with ACR Comment Letters.

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