The Hospital Outpatient Prospective Payment System (HOPPS) is used by the Centers for Medicare and Medicaid Services (CMS) to reimburse for hospital outpatient services. CMS created HOPPS to reduce beneficiary copayments in response to rapidly growing Medicare expenditures for outpatient services and large copayments being made by Medicare beneficiaries.
All covered outpatient services belong to an Ambulatory Payment Classification (APC) group. Each group of procedure (i.e., codes) within an APC is supposed to be “similar clinically and with regard to resource consumption.”
