CY 2026 Proposed OPPS APC/HCPCS Lookup Tool
This spreadsheet is a tool that allows the user to pull-up basic descriptive and payment information for an APC or HCPCS code. The Proposed OPPS APC/HCPCS lookup tool spreadsheet contains the following tabs:
Comparison of Proposed 2026 OPPS Addendum B with July 2025 Addendum B
This spreadsheet compares relative weights and payment rates at the HCPCS level, using 2026 OPPS proposed rule Addendum B compared to 2025 Addendum B (July 1, 2025 file), as downloaded from the CMS website. Spreadsheet cells highlighted in yellow were calculated by HFMA; all other information is from CMS. The Addendum B spreadsheet contains these…
Aetna’s new payment policy could leave hospitals at a disadvantage
Hospitals should take note of an insurer’s new approach regarding the two-midnight rule, especially given the potential implications if the policy becomes widely adopted. In a recent communication, Aetna said providers that contract with the company’s Medicare Advantage (MA) plans and Medicare Special Needs Plans face a new policy beginning Nov. 15 in instances when…
Comparison of Proposed 2026 OPPS Addendum A with July 2025 Addendum A
HFMA presents a spreadsheet comparing relative weights and payment rates at the APC level, using the 2026 OPPS proposed rule Addendum A compared to 2025 Addendum A.
News Briefs: Budget reconciliation bill finalized with big implications for Medicaid
Declines in coverage and spending await the healthcare industry under the budget reconciliation bill signed into law by President Donald Trump on July 4. The Congressional Budget Office (CBO) projects $912 billion in reduced Medicaid spending and 10 million additional uninsured Americans in 2034 as a result of the law known as the One Big…
Medicare final rule brings a mixed bag for FY26 hospital inpatient payments
Hospitals collectively will receive a base payment increase of 2.6% in Medicare reimbursement for inpatient care provided in FY26, according to a newly published final rule. It’s a somewhat uneventful set of regulations compared with the recently released 2026 proposed rule for Medicare outpatient payments. But hospitals were hoping for a bigger inpatient update, with…
CY 2026 OPPS/ASC Proposed Rule Summary
HFMA presents a detailed summary of the CY 2026 proposed rule updating OPPS payment policies that apply to outpatient services provided to Medicare beneficiaries and annual updates to the ambulatory surgical center payment system.
CY 2026 Physician Fee Schedule Proposed Rule Summary Part II – MSSP Requirements
HFMA presents part II of three detailed summaries of the proposed rule relating to the Medicare physician fee schedule for CY 2026 and other revisions to Medicare Part B policies.
CY 2026 Physician Fee Schedule Proposed Rule Summary – Part I
HFMA presents part I of three detailed summaries of the proposed rule relating to the Medicare physician fee schedule for CY 2026 and other revisions to Medicare Part B policies.
In comments, for-profit hospital leaders don’t dwell on ‘Big Beautiful Bill’ impact
Leaders of for-profit hospital chains ranged from noncommittal to confident in recent remarks about impending rollbacks to Medicaid and the Affordable Care Act (ACA). Hospitals have several years to prepare for some of the changes, and the interval also leaves time to modify policies in the newly passed budget reconciliation bill, health system leaders said…