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The Hospital Outpatient Prospective Payment System (HOPPS) for calendar year 2026 introduces important updates that outpatient facilities should understand as they prepare for the year ahead. With the updates finalized by the Centers for Medicare and Medicaid Services, coding and revenue cycle teams have new guidance that will influence payment, reporting, and compliance beginning January 1.
Below is a high-level look at the types of changes included in the CY 2026 HOPPS updates and why they matter.
Payment Rate Updates
CMS has finalized an increase to outpatient payment rates for facilities that meet quality reporting requirements. As in prior years, this adjustment reflects inflationary updates and productivity factors and will impact how hospitals calculate reimbursement under HOPPS. Understanding these changes is key to accurate forecasting and charge capture.
New and Emerging Technologies
The 2026 updates continue CMS’s focus on innovation, with new and revised technology-related payment policies. Changes affecting New Technology APCs and device payments may influence how certain services are reported and reimbursed in the outpatient setting.
Device and Pass-Through Payment Changes
CMS has finalized updates related to device pass-through payments, including expiring pass-through devices and newly approved technologies. Facilities using qualifying devices should review these policies closely to ensure appropriate reporting and reimbursement.
Shifts in Site of Service
As CMS begins its multi-year effort to phase out the inpatient-only list, additional procedures are becoming eligible for outpatient payment. These changes may affect where services are safely performed and how they are billed under HOPPS and ASC payment rules.
Updates Affecting ASCs
The CY 2026 rule also includes significant changes for Ambulatory Surgical Centers, including expansion of the ASC Covered Procedures List and updates to payment and policy criteria. Organizations operating ASCs should evaluate how these changes align with their current service offerings.
Quality Reporting and Compliance Considerations
CMS has finalized updates to hospital outpatient quality reporting measures, including measure removals, modifications, and new reporting requirements that will affect future payment determinations.
Download Your HOPPS 2026 Update Resource Now
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.
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Courses are available across various coding types including CPT, E/M, ICD-10-CM, and ICD-10-PCS, and are designed for multiple specialties including inpatient, outpatient, profee, and CDI.
To stay up to date, coders can explore our Coding Updates hub for the latest ICD-10-CM, ICD-10-PCS, CPT, and IPPS changes. HIAlearn also supports organizations with group discounts and scalable team access, promoting accuracy, compliance, and continuous professional development across departments.
The information contained in this blog post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
