Hospital Outpatient Alert: Payment System Changes — Action Required by 2026
Significant changes to OPPS and ASC payment systems effective January 1, 2026.
Action required by
January 1, 2026
Review the Action Required section below and ensure your team has completed all compliance steps before this date.
The Federal Register Final Rule (Policy ID: FR-2025-20907) outlines significant changes to the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment systems effective January 1, 2026.
What Changed These changes will impact reimbursement rates for outpatient services, with adjustments made to payment rates for various procedures and services provided in hospital outpatient departments and ASCs. The methodology used to calculate payment rates will be updated, potentially leading to increased or decreased reimbursement for specific services. While specific CPT, HCPCS, or ICD-10 codes affected by these changes are not detailed, clinical coders should refer to the source document for a comprehensive list of impacted codes.
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Quick answers
What are the key changes in the OPPS and ASC payment systems?
The changes include adjustments to payment rates and updates to the methodology for calculating these rates.
How can I find the specific codes affected by these changes?
Refer to the Federal Register Final Rule (Policy ID: FR-2025-20907) for a comprehensive list of impacted codes.
What should I do to ensure compliance with the new regulations?
Familiarize yourself with the new regulations, attend training sessions, and review updated coding manuals.
Content summarized from publicly available federal publications including CMS, MAC contractors, and the Federal Register. CLV Intelligence is not affiliated with or endorsed by any government agency. This is not legal or medical advice.