Federal Register Final Rule: Medicare Program; Hospital Outpatient Prospective Payment System: Remedy for the 340B-Acquired Drug Payment Policy for Calendar Years 2018-2022
Hospital Outpatient (OPPS) · Effective 2024-01-08
Specialty intelligence
Hospital Outpatient (OPPS) Reimbursement Alerts
Daily CMS policy updates, MAC LCD revisions, and coding guidance for Hospital Outpatient (OPPS) billing teams. All alerts sourced directly from CMS, MAC contractor sites, and the Federal Register.
Total alerts
27
Average signal
73/100
Sources monitored
15+
Latest Hospital Outpatient (OPPS) alerts
27Federal Register Final Rule: Medicare Program; Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Rating; Hospital Price Transparency; and Notice of Closure of a Teaching Hospital and Opportunity To Apply for Available Slots; Correction
Hospital Outpatient (OPPS) · Effective 2026-02-23
Federal Register Final Rule: Medicaid Program; Disproportionate Share Hospital Third-Party Payer Rule
Hospital Outpatient (OPPS) · Effective 2024-04-23
+ 24 more Hospital Outpatient (OPPS) alerts
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MAC contractor coverage
Hospital Outpatient (OPPS) billing is subject to both national CMS policy and regional MAC contractor Local Coverage Determinations (LCDs). CLV Intelligence monitors all MAC contractor sites — Noridian, CGS, First Coast, NGS, Novitas, Palmetto GBA, and WPS — for LCD updates affecting Hospital Outpatient (OPPS) codes. Coverage criteria vary by contractor jurisdiction.
NoridianCGS AdministratorsFirst CoastNational Government ServicesNovitas SolutionsPalmetto GBAWPS
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Weekly digest of CMS and MAC policy changes for Hospital Outpatient (OPPS) billing teams.
Frequently asked questions
What MAC contractors issue LCDs for Hospital Outpatient (OPPS) billing?
Hospital Outpatient (OPPS) billing is subject to regional Local Coverage Determinations (LCDs) from all seven Medicare Administrative Contractors: Noridian, CGS Administrators, First Coast Service Options, National Government Services, Novitas Solutions, Palmetto GBA, and WPS Government Health Administrators. Coverage criteria and medical necessity requirements vary by contractor jurisdiction. CLV Intelligence monitors all MAC contractor sites daily for LCD updates affecting Hospital Outpatient (OPPS) codes.
How often does CMS update Hospital Outpatient (OPPS) reimbursement policy?
CMS updates the Physician Fee Schedule annually, effective January 1, with proposed rules published in the summer and final rules in November. MAC contractors issue LCD updates on a rolling basis throughout the year with no fixed schedule. The Federal Register publishes proposed and final rules affecting Hospital Outpatient (OPPS) reimbursement on a continuous basis. CLV Intelligence monitors all three sources daily and surfaces updates by signal strength.
What is a Local Coverage Determination (LCD) and how does it affect Hospital Outpatient (OPPS) billing?
A Local Coverage Determination (LCD) is a decision by a Medicare Administrative Contractor specifying under what clinical circumstances a particular service is covered within its geographic jurisdiction. For Hospital Outpatient (OPPS) billing teams, LCDs define medical necessity criteria, covered diagnoses, and documentation requirements for specific procedures. Failure to comply with LCD requirements is among the most common causes of Medicare claim denial in Hospital Outpatient (OPPS) practices.
Reimbursement guides & resources
Plain-language guides to the policy cycles that drive Hospital Outpatient (OPPS) reimbursement — the fee schedule, ICD-10, HCPCS, and Local Coverage Determinations.
2027 Fee Schedule Guide
How the CY2027 Medicare Physician Fee Schedule works and what to track.
ICD-10 Change Center
The FY2027 ICD-10-CM update cycle and the October 1 effective date.
HCPCS Quarterly Update
How HCPCS Level II changes every quarter — Jan, Apr, Jul, Oct.
Tracking LCD Changes
How LCDs change across all seven MACs and how to track them.
2027 Prep Checklist
A free, printable checklist for the CY2027 fee schedule cycle.
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