The Centers for Medicare and Medicaid Services (CMS) released the 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule on July 15. CMS proposes a 2.4% increase to OPPS payment rates that reflects a market basket update of 3.2% reduced by a productivity adjustment of 0.8%.

View highlights from the proposed rule regarding payment policy, rate setting and other provisions below.

• CMS proposes adding cardiac catheter ablation procedures to the ASC covered procedures list (CPL). Such an addition has been a key point of effort for the ACC, Heart Rhythm Society and other stakeholders in recent years.
• The addition of ablation services to the CPL is part of a larger proposal to revise the criteria for adding procedures to the ASC CPL. CMS proposes adding 276 codes under this new rubric.
• The agency proposes to 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. 271 codes removed from the IPO list are also proposed for addition to the ASC CPL.
• Acknowledging the struggle to incorporate Software as a Service (SaaS) into payment structures, CMS again seeks feedback from the public on payment policies that may inform a comprehensive approach in the future.
• Revising prior policy, CMS proposes to establish a new C-code to report and capture an Add-on Payment for Technetium-99m (Tc-99m) derived from domestically produced Molybdenum-99 (Mo-99). At least 50% of the Mo-99 used in the Tc-99m generator must have been domestically produced for a Tc-99m dose to qualify for the add-on payment.
• Ambulatory payment classification (APC) payments for cardiac PET/CT are proposed to change for 78432 (reduced from $1850.50 to $1750.50), 78433 (increase from $1950.50 to $2250.50) with 78431 remaining the same.
• The proposed rule includes a new coronary plaque assessment code to be placed in APC 1511 with a base payment rate of $950.50.
• CMS proposes to raise the threshold for radiopharmaceuticals to be paid separately from a per-day cost of $630 to $655 based on trends in the Producer Price Index.
• CMS proposes to make permanent the allowance for direct supervision of cardiac rehabilitation, intensive cardiac rehabilitation and pulmonary rehabilitation services via audio-visual real-time communications, excluding audio-only and diagnostic services with an 010 or 090 global surgery indicator.
• The proposed rule also enhances the role of patient safety weight in hospital star ratings for hospitals in the lowest quartile for Safety of Care by capping ratings at four stars in 2026 and applying a one-star reduction in 2027. These changes apply only to hospitals with at least three safety measures.
• CMS plans to adopt the Information Transfer Patient-reported Outcome-based performance measure in the ASC Quality Reporting Program.
• The agency also extends voluntary reporting of the Excessive Radiation Dose or Inadequate Image Quality for Diagnostic CT in Adults electronic clinical quality measure (eCQM) and proposes adopting the Emergency Care Access & Timeliness eCQM in the Hospital Outpatient Quality Reporting Program.
• The proposed rule removes health equity, social determinants of health, and COVID-19 vaccination quality measures from quality reporting programs.

Additional information on the proposed rule can be found in the OPPS Press Release and Fact Sheet. ACC Advocacy staff will continue to provide more detailed information on elements of the proposed rule in the weeks ahead and develop formal comments within the 60-day comment period. Look for updated information on ACC.org/Advocacy and in upcoming issues of the ACC Advocate newsletter.

Keywords: ACC Advocacy, Centers for Medicare and Medicaid Services, U.S., Outpatients, Hospitals, Policy