CY 2026 Hospital Outpatient Prospective Payment System (HOPPS) Updates: What You Need to Know

Every year, the Centers for Medicare and Medicaid Services (CMS) announce key updates to the Hospital Outpatient Prospective Payment System (HOPPS) and the Medicare Ambulatory Surgical Center (ASC) system. These updates, effective January 1, ensure compliance and help healthcare organizations optimize their reimbursement strategies.

For calendar year 2026, CMS has finalized several policy and payment updates that outpatient departments, ambulatory surgery centers, coders, and revenue cycle teams need to be aware of before the new year begins. While some updates continue trends from prior years, others signal meaningful shifts in how services are paid and where care may be provided.

Staying current with these changes is essential for maintaining compliance, understanding payment impacts, and ensuring coding and charging practices align with CMS expectations.

Key Areas of Change from the 2026 HOPPS Updates:

• Payment rate updates tied to quality reporting requirements
• New and revised New Technology APCs
• Changes to device pass-through payment eligibility
• Phase-out of the inpatient-only list
• Significant expansion of the ASC Covered Procedures List
• Separate payment policies for select products and services
• Updates to non-opioid pain management payments
• Modifications to hospital outpatient quality reporting measures

These updates can influence everything from procedural decisions to reimbursement forecasting and compliance risk.

Get the Highlights of the 2026 Updates

Want to learn more? Download our CY 2026 HOPPS Updates Document today! This guide highlights major updates that will have practical implications for your organization. Download Now and see what’s in store for your team with the January 1 changes.

For a deeper dive into the details of these and other updates, explore our CY 2026 CPT and HOPPS Updates Course on HIAlearn. This course not only covers the updated CPT codes but also provides actionable insights for your coding and compliance teams.