CMS Releases 2026 Hospital OPPS Final Rule
News | Published: Friday, November 21, 2025
ACC.org News Story
The Centers for Medicare and Medicaid Services (CMS) has issued the 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. CMS has finalized a 2.6% increase to OPPS payment rates that reflects a market basket update of 3.3% reduced by a productivity adjustment of 0.7%. Read about additional provisions from the final rule below.
- The final rule adds cardiac catheter ablation procedures to the ASC covered procedures list (CPL). The ACC, Heart Rhythm Society and other stakeholders have advocated to allow ablation services to be performed in the ambulatory setting in recent years. This addition is part of a larger move to revise the criteria for adding procedures to the ASC CPL.
- The agency will phase out the inpatient-only (IPO) list of services that can only be performed on an inpatient basis over the next three years. Services removed from the IPO list would be exempt from the two-midnight policy in 2026 and beyond until they are established in the outpatient setting.
- Through a restructuring of the diagnostic test ambulatory payment classifications (APCs), OPPS payment for stress tests (93017) and other services provided in the outpatient facility under Level 2 Diagnostic Tests APC 5722 will decline from a national rate of $311.40 to $220.60.
- The agency previously removed high-cost radiopharmaceuticals over $630 from APCs. Those services remaining in APCs will now see reduced payments. Despite concerns from the ACC and others, OPPS payment for amyloid imaging (78803) under Level 2 Nuclear Medicine Services APC 5592 is reduced from a national rate of $1,305.48 in 2025 to $554.73 in 2026.
For more information on the final rule, access the OPPS Press Release, OPPS Fact Sheet, a Hospital Price Transparency Fact Sheet, and Addenda. This Trending Story will be updated with a more detailed summary of changes to quality measures and other topics in this rule in the coming days. Look for the latest information on MedAxiom.com and ACC.org/Advocacy and in upcoming issues of MedAxiom Minute, Daily News and the ACC Advocate newsletter.
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