№ files_lp_4_process_2_63862
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Technical guide detailing the updated outpatient and inpatient Medicare fee schedules, hospital-specific rate adjustments, and reimbursement policies based on FY 2026 IPPS Final Rule for discharges on or after December 1, 2025.
Year:
2025
Effective Date:
December 1, 2025
Regulatory Source:
Medicare FY 2026 IPPS Final Rule (CMS-1833-F)
Document Type:
Regulatory update
Issued by:
Centers for Medicare & Medicaid Services (CMS)
Data Sources:
FY 2026 Final Rule, Federal Register Vol. 90 FR 36536
Applicable Facilities:
Acute care hospitals, long-term care hospitals, sole community hospitals
Key Metrics:
Operating costs, capital-related costs, wage index adjustments, DSH adjustment, CCR, outlier payments, DRG relative weights
Target Audience:
Hospital administrators, billing and compliance staff, healthcare policymakers
Update Scope:
OMFS rates, composite payment calculation, DRG relative weights, acute care transfer policies
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2025
Region / City:
United States
Theme:
Medicare and Medicaid Programs, Hospital Outpatient Payment Systems, Ambulatory Surgical Centers
Document Type:
Final Rule
Organization / Institution:
Centers for Medicare & Medicaid Services (CMS)
Author:
Centers for Medicare & Medicaid Services (CMS)
Target Audience:
Healthcare providers, hospitals, ambulatory surgical centers
Period of Validity:
Effective March 1, 2025
Approval Date:
November 27, 2024
Amendment Date:
January 2, 2025
Note:
Description
Year:
2020
Region / City:
United States
Topic:
Medicare updates to Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems
Document Type:
Regulatory update
Author:
Centers for Medicare & Medicaid Services (CMS)
Target Audience:
Healthcare providers and administrators
Period of validity:
March 1, 2020
Approval Date:
November 12, 2019
Amendment Date:
January 3, 2020
Context:
This document is a regulatory update detailing changes to Medicare payment systems for outpatient hospital and ASC services effective from March 1, 2020.
Year:
2026
Region / City:
California
Document Type:
Regulatory Update
Author:
Centers for Medicare and Medicaid Services (CMS)
Target Audience:
Healthcare providers, healthcare administrators, regulatory professionals
Effective Period:
March 1, 2026
Approval Date:
January 28, 2026
Date of Changes:
November 28, 2025
Year:
2025
Region / City:
United States
Topic:
Medicare Physician Fee Schedule
Document Type:
Regulatory Update
Agency:
Centers for Medicare and Medicaid Services (CMS)
Author:
CMS
Target Audience:
Healthcare professionals, Medicare service providers
Period of Effect:
February 1, 2025
Approval Date:
December 23, 2024
Amendment Date:
Not specified
Year:
2022
Region/City:
California
Subject:
Medicare Physician Fee Schedule Updates
Document Type:
Regulation
Organ/Institution:
Centers for Medicare and Medicaid Services (CMS)
Author:
Centers for Medicare and Medicaid Services
Target Audience:
Healthcare Providers
Period of Effectiveness:
January 1, 2022
Approval Date:
November 19, 2021
Date of Changes:
January 1, 2022
Year:
2021
Region / City:
United States
Topic:
Medicare Physician Fee Schedule
Document Type:
Regulatory Update
Organization / Institution:
Centers for Medicare & Medicaid Services (CMS)
Author:
Centers for Medicare & Medicaid Services
Target Audience:
Healthcare Providers, Medical Practitioners
Period of Effectiveness:
March 1, 2021
Approval Date:
December 28, 2020
Date of Changes:
March 1, 2021
Year:
2021
Region / City:
United States
Subject:
Medicare Program; Hospital Outpatient Payment System
Document Type:
Regulatory Update
Organization / Institution:
Centers for Medicare & Medicaid Services (CMS)
Author:
Centers for Medicare & Medicaid Services (CMS)
Target Audience:
Healthcare Providers, Hospitals, Medical Administrators
Effective Period:
From March 1, 2021
Approval Date:
December 29, 2020
Amendment Date:
January 27, 2021
Year:
2023
Region / City:
United States
Subject:
Medicare Payment Systems for Hospital Outpatient and Ambulatory Surgical Center Services
Document Type:
Regulation / Federal Rule
Agency / Organization:
Centers for Medicare & Medicaid Services (CMS)
Author:
Centers for Medicare & Medicaid Services (CMS)
Target Audience:
Healthcare providers and administrators in outpatient and ambulatory surgical services
Period of Application:
Starting March 1, 2023
Approval Date:
November 23, 2022
Amendment Date:
November 4, 2022; December 13, 2022
Document Reference:
CMS-1772-FC; CMS-1771-F; CMS-1771-F2; CMS-1771-CN
Official Publication:
Federal Register
Year:
2024
Region / City:
California
Topic:
Health Regulations
Document Type:
Official Order
Agency / Institution:
California Department of Industrial Relations
Author:
George P. Parisotto
Target Audience:
Healthcare Providers, Regulatory Bodies
Effective Date:
February 15, 2024
Approval Date:
January 11, 2024
Modification Date:
February 22, 2024
Context:
Official regulation update for hospital outpatient and ambulatory surgical services fee schedules based on CMS rules, effective February 15, 2024.
Year:
2022
Region / City:
California
Document Type:
Administrative Order
Organization:
California Department of Industrial Relations, Division of Workers’ Compensation
Author:
George P. Parisotto
Target Audience:
Healthcare providers, regulatory bodies
Period of Effectiveness:
July 1, 2022, onwards
Date of Approval:
July 20, 2022
Date of Last Change:
July 12, 2022
Year:
2024
Region / City:
California
Topic:
Inpatient Hospital Fee Schedule Adjustments
Document Type:
Official Order
Organization / Institution:
California Department of Industrial Relations
Author:
George P. Parisotto
Target Audience:
Workers’ Compensation stakeholders, Healthcare providers, Legal professionals
Period of Validity:
Effective December 1, 2024
Approval Date:
November 1, 2024
Date of Changes:
October 2, 2024 (Correction), October 3, 2024 (Interim Final Action)
Context:
Legal order updating the inpatient hospital fee schedule in compliance with federal Medicare regulations, effective for discharges occurring on or after December 1, 2024.
Year:
2022
Region / City:
California
Document Type:
Order
Institution / Organization:
California Department of Industrial Relations, Division of Workers’ Compensation
Author:
George P. Parisotto
Target Audience:
Healthcare providers, hospital outpatient departments, ambulatory surgical centers
Effective Period:
From October 1, 2022
Approval Date:
October 4, 2022
Modification Date:
November 21, 2022
Year:
2021
Region / City:
United States
Topic:
Medicare Program, Hospital Inpatient Prospective Payment Systems
Document Type:
Federal Regulation
Institution:
Centers for Medicare and Medicaid Services (CMS)
Author:
Centers for Medicare and Medicaid Services
Target Audience:
Hospitals, Healthcare Providers
Period of Validity:
Effective for discharges occurring on or after December 1, 2021
Approval Date:
August 13, 2021
Amendment Date:
October 20, 2021
Description:
Updates to the Medicare Hospital Inpatient Prospective Payment System for Acute Care Hospitals and Long-Term Care Hospitals, including rate changes and policy amendments for FY 2022.
Year:
2024
Region / City:
United States
Topic:
Medicare and Medicaid Hospital Payment Systems
Document Type:
Federal Rule
Author:
Centers for Medicare and Medicaid Services (CMS)
Target Audience:
Healthcare providers, hospital administrators, policy makers
Period of Action:
December 1, 2024 and beyond
Approval Date:
August 28, 2024
Amendment Date:
October 2, 2024
Context:
Regulatory document outlining updates to the Medicare and Medicaid hospital inpatient payment system, including revised payment rates and related policies for fiscal year 2025.
Year:
2025
Region / City:
California
Document Type:
Order
Organization / Institution:
State of California, Department of Industrial Relations, Division of Workers’ Compensation
Author:
George P. Parisotto
Target Audience:
Medical service providers, healthcare administrators, policy professionals
Period of Validity:
Effective from April 1, 2025
Approval Date:
April 4, 2025
Date of Changes:
April 4, 2025
Context:
Administrative order updating the Official Medical Fee Schedule for Hospital Outpatient Departments and Ambulatory Surgical Centers in California to align with the April 2025 Medicare changes, including updates to payment systems and codes.
Year:
1997
Region / City:
United States
Topic:
Inpatient medication management
Document Type:
Manual
Organization / Institution:
Department of Veterans Affairs
Author:
Not specified
Target Audience:
Healthcare professionals in the Veterans Affairs system
Effective Period:
Ongoing updates
Approval Date:
December 1997
Revision Date:
August 2025
Year:
2026
Region / City:
United States
Subject:
Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) & Quality Reporting Program (QRP)
Document Type:
Supporting Statement
Agency:
Centers for Medicare & Medicaid Services (CMS)
Author:
U.S. Department of Health and Human Services
Target Audience:
Healthcare professionals, policymakers, and administrators in rehabilitation facilities
Effective Date:
October 1, 2026
Date of Approval:
Not specified
Date of Revision:
March 29, 2024
Expiration Date:
Not specified
Year:
2023
Region / City:
UK, Cyprus, Overseas
Subject:
Military Mental Health, Psychotherapy, Inpatient and Outpatient Services
Document Type:
Statement of Requirement
Organ / Institution:
Defence Medical Services
Author:
Defence Primary Healthcare
Target Audience:
Military Personnel, Healthcare Providers, Service Authorities
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Amendments:
Not specified
Year:
2005
Region / City:
United States
Topic:
Health Systems Design and Development
Document Type:
Release Notes
Organization / Institution:
Department of Veterans Affairs
Author:
Department of Veterans Affairs
Target Audience:
Health care professionals using CPRS
Period of Validity:
April 2006
Approval Date:
1/31/2005
Modification Date:
5/18/2005