Health Policy Affairs

On Nov. 21, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the final rule for the Hospital Outpatient Prospective Payment System (HOPPS) for Calendar Year (CY) 2026.

Payment Rates

• CMS finalized a 2.6% payment increase for the HOPPS and Ambulatory Surgery Centers (ASCs) for CY 2026, reflecting a 3.3% market basket update offset by a 0.7% productivity reduction.

• The HOPPS conversion factor (CF) is set at $91.415 for hospitals that meet quality reporting requirements and $89.958 for those that do not meet quality reporting requirements.

• CMS will delay a 2% annual CF reduction for certain hospitals under the 340B Final Remedy Rule until 2027.

• Total HOPPS payments are projected to reach $101 billion, up $8 billion from CY 2025. Cancer hospitals will have a finalized payment-to-cost ratio of 0.87.

Ambulatory Payment Classification (APC)

• CMS will continue using the multiple imaging composite APC methodology, and finalized several new technology APC assignments, including LimFlow TADV and Liver Histotripsy procedures.

Eliminating the Inpatient Only (IPO) List

• CMS finalized a three-year phase-out of the Inpatient-Only (IPO) list, beginning with 285 procedures to be removed in CY 2026.

  • For interventional radiology this includes the removal of CPT codes 37182 (Insertion of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract formation/dilatation, stent placement and all associated imaging guidance and documentation) and 61624 (Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method; central nervous system (intracranial, spinal cord)) from the IPO only list effective January 1, 2026.

Diagnostic radiopharmaceuticals

• A $655 per-day cost threshold was finalized for specific diagnostic radiopharmaceuticals.

Applications for device pass-through status

• CMS approved device pass-through payment for the VasQ, a nitinol implant which is surgically placed outside and/or around an artery and/or vein to provide external support to arteriovenous fistulas created for vascular access by means of vascular surgery for CY 2026.