CMS Finalizes Site-Neutral Payments for Non-Contrast Imaging Services in OPPS

CMS released the calendar year (CY) 2027 Hospital Outpatient Prospective Payment System (HOPPS) final rule Nov. 4. ACR^® has developed an initial summary outlining key provisions of the final rule relevant to radiology. The finalized policies take effect Jan. 1, 2027.

Of particular importance to radiology, CMS finalized a site-neutral payment policy for certain non-contrast imaging services furnished in excepted off-campus hospital outpatient departments. Beginning in CY 2027, CMS will pay the Physician Fee Schedule-equivalent rate for services assigned to the non-contrast imaging APCs 5521 through 5524, which include certain bone density scans, X-rays, ultrasounds, CT scans and MRIs. Rural sole community hospitals are exempt from the policy. CMS estimates the change will reduce Medicare Part B expenditures by approximately $260 million in the first year.

ACR’s initial summary also highlights the finalized $99.970 OPPS conversion factor, imaging APC payment rates and code placements, payment policies for Software as a Medical Service (SaMS), diagnostic radiopharmaceuticals, 340B-acquired drugs and other provisions affecting radiology.

ACR is continuing to review the final rule and will provide a more detailed summary in the coming weeks. For more information, contact Kimberly Greck, ACR Senior Economic Policy Analyst.