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%.

View highlights from the final rule regarding payment policy, rate setting and other provisions 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 for allowing 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 placement in Level 2 Nuclear Medicine Services APC 5592 is reduced to $554.73 in 2026 from a national rate of $1,305.48 in Level 3 Nuclear Medicine Services APC 5593 in 2025.
• CMS establishes 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.
• APC payments for cardiac PET/CT codes 78431 and 78433 have been finalized as proposed with 78431 remaining the same as 2025 and 78433 increasing from $1,950.50 to $2,250.50 based on new APC assignments derived from cost data analysis. CMS previously proposed reducing 78432 from $1,850.50 to $1,750.50 via APC reassignment. However, based on updated cost data, 78432 has been reassigned to an APC that further lowers the payment from $1,850.50 to $1,550.50.
• The new coronary plaque assessment code, 75577, has been placed in APC 1511 with a base payment rate of $950.50.
• The threshold for radiopharmaceuticals to be paid separately has been raised from a per-day cost of $630 to $655 based on trends in the Producer Price Index.
• The final rule makes the allowance for direct supervision of cardiac rehabilitation, intensive cardiac rehabilitation and pulmonary rehabilitation services via audio-visual real-time communications permanent, excluding audio-only and diagnostic services with an 010 or 090 global surgery indicator.
• The 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 will 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 will adopt the Emergency Care Access & Timeliness eCQM in the Hospital Outpatient Quality Reporting Program.
• The rule removes health equity, social determinants of health and COVID-19 vaccination quality measures from quality reporting programs.

For more information on the final rule, access the OPPS Press Release, OPPS Fact Sheet, a Hospital Price Transparency Fact Sheet and Addenda. Look for the latest information on ACC.org/Advocacy and in upcoming issues of the ACC Advocate newsletter.

Plus, visit the ACC's Action Alerts webpage for ways to advocate for the financial stability of physician practices and preserving Medicare beneficiaries' access to care.

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