Hospital Outpatient PPS


Hospital Outpatient Prospective Payment System Rulemaking

CMS issued the CY 2022 OPPS/ASC final rule and related files that update Medicare payment rates, quality reporting programs, and policies. See a summary of key provisions, effective January 1, 2022:

  • Price Transparency of Hospital Standard Charges
  • Beneficiary Protections
  • Health Equity, Access to Emergency Care in Rural Areas, & Lessons from COVID-19
OPPS Drugs and Biologicals with Quarterly Restated Payment Rates

Some drugs and biologicals based on ASP methodology may have payment rates that are corrected retroactively. These retroactive corrections typically occur on a quarterly basis as a part of the OPPS payment system quarterly update change request. Beginning with the January 2015 OPPS payment system quarterly update change request, the list of drugs and biologicals with corrected payments rates, for a particular quarter, are accessible from the left menu link titled "Restated Drug and Biological Payment Rates".

Hospital Center

For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) hospitals, go to the Hospital Center (see under "Related Links Inside CMS" below). Mailbox:

For files to order, see Limited Data Set Files - Hospital Outpatient Prospective Payment System and the Identifiable Data Files.  

Page Last Modified:
12/01/2021 08:00 PM