Economics
On July 2, 2026, the Centers for Medicare and Medicaid Services (CMS) issued the proposed rule for the Hospital Outpatient Prospective Payment System (HOPPS) for calendar year (CY) 2027.
Payment rates
- CMS proposed a 2.4% payment increase for OPPS hospitals and ambulatory surgery centers (ASCs) that meet applicable quality reporting requirements.
- For OPPS hospitals, the proposed conversion factor (CF) is $102.004 for hospitals that meet quality reporting requirements and $100.015 for hospitals that do not.
- For ASCs, the proposed CF is $57.766 for ASCs that meet quality reporting requirements and $56.638 for ASCs that do not.
- CMS proposed to pay for 340B acquired drugs at the drug’s average sales price (ASP) -33.4%.
- CMS proposed expanding site-neutral payments to imaging services without contrast performed in excepted off-campus provider-based departments (PBDs), aligning payment more closely with physician office rates. Rural Sole Community Hospitals would be exempt.
- CMS proposed a cancer hospital payment-to-cost ratio (PCR) of 0.88 for the 11 designated cancer hospitals.
Ambulatory Payment Classifications (APCs)
- CMS proposed reassigning LimFlow and liver histotripsy services to new APCs.
- The DETOUR System would no longer receive separate pass-through payment after CY 2026, with device costs packaged into payment for the associated procedure.
- CMS proposed assigning CPT 60660 (thyroid nodule ablation) a “P2” status indicator in the ASC setting, resulting in payment based on the Medicare Physician Fee Schedule rather than OPPS rates.
- CMS proposed removing 637 additional procedures from the IPO list as part of its continued effort to phase out the list.
- CMS proposed maintaining the $655 per-day cost threshold for qualifying non-pass-through, separately payable diagnostic radiopharmaceuticals.
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SIR summary: Hospital Prospective Payment System Proposed Rule for 2027
On July 2, 2026, the Centers for Medicare and Medicaid Services (CMS) issued the proposed rule for the Hospital Outpatient Prospective Payment System (HOPPS) for calendar year (CY) 2027.
-
Guidewire
PAD Coalition cheers inclusion of screening language in appropriations bills
SIR joined the PAD Coalition in thanking the House Appropriations Committee for including report language on peripheral artery disease education, screening and amputation prevention in the FY 2027 Labor-HHS-Education appropriations report.
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Guidewire
SIR supports bill to keep prior authorization out of Medicare Advantage
The Improving Seniors' Timely Access to Care Act reached 290 House cosponsors, allowing a motion to place the bipartisan Medicare Advantage prior authorization reform bill on the House consensus calendar for a floor vote.
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Guidewire
CMS releases new ICD-10-CM codes
CMS released the 2027 ICD-10-CM diagnosis code files, including 190 new, 30 deleted and 4 revised codes that will apply to patient encounters beginning Oct. 1, 2026.
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Guidewire
New CPT® adviser appointments for SIR
Julie C. Bulman, MD, and Alexandra Fairchild, MD, FSIR, were appointed to the AMA CPT® Advisory Committee, where they will represent interventional radiology and help shape the CPT® code development process.
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House committee votes to nix WISeR Model
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