CMS Updates HOPPS Pay Rate For Anatomical Segmentation Code

The Centers for Medicare and Medicaid Services (CMS) releases updates every quarter to the Hospital Outpatient Prospective Payment System (HOPPS) that outline changes in policies and relevant billing instructions for hospitals. In the January update, the new Healthcare Common Procedure Coding System (HCPCS) code C8001 was established to describe the 3D anatomical segmentation imaging intended as software for preoperative surgical planning, and as software for the intraoperative display of the aforementioned multi-dimensional digital images.

CMS in the April update revised the APC (Ambulatory Payment Classification) category, which determines the payment rate, from APC 5521 (Level 1 Imaging without Contrast) with payment rate of $88.05 to APC 5721 (Level 1 Diagnostic Tests and Related Services) with payment rate of $156.46. This code is separately paid within the HOPPS but is not reimbursable under the Medicare Physician Fee Schedule, as C-codes are only used by CMS within the HOPPS for tracking the costs of new and evolving services and devices.

The American College of Radiology^® (ACR^®) staff will monitor any additional changes contained within the 2026 HOPPS Proposed Rule, to be released in July.

If you have questions, contact Kimberly Greck, ACR Senior Economic Policy Analyst.