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CMS issues HOPPS Proposed Rules for 2021

August 4, 2020

On August 4, 2020, the Centers for Medicare and Medicaid Services (CMS) released the 2021 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule, which includes modest payment increases for radiation therapy services effective January 1, 2021. Comments on the proposed rule are due October 5, 2020.

In the Medicare hospital outpatient environment, hospital reimbursement is based on Ambulatory Payment Classifications or APCs. CMS assigns CPT codes to an APC based on clinical and resource use similarity. All services in an APC are reimbursed at the same rate. Cost data collected from OPPS claims are used to calculate rates. Certain services are considered ancillary and their costs are packaged into the primary service. Packaged services do not receive separate payment. For example, in the hospital outpatient environment imaging is not paid separately when reported with treatment delivery services.

The complete summary of key issues impacting radiation oncology is available online. Also, access the HOPPS proposed rule and related addenda.