SIR summary: Hospital Prospective Payment System Proposed Rule for 2026

Payment rates

• CMS proposed a 2.4% increase to the outpatient department (OPD) fee schedule for HOPPS and Ambulatory Surgery Centers (ASCs). Based on the market update from the Inpatient Prospective Payment System (IPPS) of 3.2% and a 0.8% productivity adjustment decrease.   
• Proposed a conversion factor (CF) of $91.747 for hospitals that meet the Hospital Outpatient Quality Reporting (OQR) requirements and applies the 2% reduction to those that do not, with a CF equal to $89.958. 
• Under the 340B Final Remedy Rule, CMS proposed to impose an annual 2% reduction to HOPPS CF beginning in CY 2026 for non-drug items and services for hospitals in which this adjustment applies. The proposed CF for these hospitals is $89.958. Ambulatory Surgery Centers (ASCs) are not impacted by the 2% reduction for the 340B offset remedy.
• CMS estimates total payments to HOPPS providers will be approximately $100.0 billion, which is an increase of roughly $8.1 billion compared to CY 2025 HOPPS payments. 
• Cancer hospital payment-to-cost ratio (PCR) proposed for CY 2026 at 0.87 for the 11 designated hospitals.  

Ambulatory payment classifications (APCs) 

• CMS proposed to continue to pay for all multiple imaging procedures within an imaging family performed on the same date of service using the multiple imaging composite APC payment methodology.
  • Standard APC assignments will continue to apply for single imaging procedures and multiple imaging procedures performed across imaging families.  A single imaging session performed “with contrast” is part of a composite APC when at least one or more imaging procedures from the same family are also performed with contrast on the same date of service. For example, if a hospital performs one MRI without contrast during the same session as one with contrast, the payment rate will be for the “with contrast” composite APC.
• CMS proposes to assign several new technologies to new APCs for CY 2025.
• Proposed for services to new technology APCs based on requestor applications
  • LimFlow TADV procedure CPT Code 0620T (APC 1579)
  • Liver Histotripsy Service CPT Code 0686T (APC 1579)
    

Eliminating the inpatient only list

• CMS proposed to phase out the inpatient only (IPO) list over a 3-year period, beginning with the removal of 285 mostly musculoskeletal procedures for CY 2026 and completing the changes by Jan. 1, 2029.
  • For interventional radiology this includes the proposed 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 [e.g., 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 Jan. 1, 2026. 
    

Diagnostic radiopharmaceuticals

• CMS proposed a per-day cost threshold of $655 for qualifying nonpass-through, separately payable diagnostic radiopharmaceuticals.