CMS Issues Final OPPS Rule, Includes Transparency Law Changes

November 9, 2023

On November 2, The Centers for Medicare & Medicaid Services (CMS) released its calendar year (CY) 2024 outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) final rule. The rule increases OPPS rates by a net 3.1% in CY 2024 compared to CY 2023. While the increase is slightly more than in the proposed rule, it falls well short of the increase to labor and other operational costs. In its comments, WSHA advocated for an increase that better reflects increases to the cost of providing care. In the next few weeks, WSHA will send an analysis of the final rule, including hospital-specific impacts, to the CFO or other designated finance person at each member hospital. Other highlights of the final rule:

  • Creates standardized formats for hospital price transparency files, including additional required data elements, and establishes additional CMS enforcement mechanisms for reporting requirements.
  • Creates Medicare benefit and coverage for intensive outpatient programs (IOPs) for behavioral health conditions.
  • Adopts some of the proposed new measures for the Outpatient and ASC quality reporting programs and all proposed measures for the REH quality reporting program.
  • Continues to pay for 340B acquired drugs and biologicals at the average sales price (ASP) plus 6%. Finalizes proposal to transition to single “TB” modifier for 340B drugs.

(Andrew Busz,


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