CMS Finalizes Hospital Outpatient Payments for 2026

On Friday, Nov. 21, the Centers for Medicare & Medicaid Services (CMS) released the Hospital Outpatient Prospective Payment System final rule, which sets Medicare payment policy for 2026.

Despite ASNC’s strong advocacy, directly with CMS, and YOUR grassroots efforts, the agency finalized proposals unfavorable to nuclear cardiology. In the months ahead, ASNC will focus on better aligning Medicare reimbursement with the cost of delivering nuclear cardiology services, including providing ASNC members with resources for engaging with their hospitals to ensure accurate cost reporting. CMS uses these data to calculate reimbursement rates.

Based on an initial review of the final rule, ASNC believes the policies below will have the most impact on nuclear cardiology in 2026:

Hospital Payment Update

CMS has finalized a 2.6 percent facility payment increase for hospital outpatient departments that meet quality reporting requirements.

PYP/Amyloid Imaging (CPT Code 78803)

CMS finalized reassignment of CPT 78803 (Radiopharm. Localization of Tumor, Inflammatory Process or Distribution of Radiopharm agent(s) (includes vascular flow and blood pool imaging, when performed); Tomographic (SPECT), Single Area (eg, head, chest, pelvis) to new APC 5592 (Level 2 Nuclear Medicine and Related Services). This reassignment results in a 57 percent reduction in the reimbursement rate for PYP service if billed using CPT 78803.

In a meeting with CMS staff, ASNC argued the agency’s new policy of paying separately for radiopharmaceuticals over a certain threshold could be impacting the geometric mean for CPT 78803 and, therefore, CMS should delay reassigning the code to allow time for hospitals to adjust and for additional geometric mean data to accumulate. CMS did not accept ASNC’s feedback but noted it would reevaluate the APC assignment for CPT 78803 in the next rule-making cycle. In the meantime, ASNC will redouble efforts to educate members about hospital cost reporting and how it can impact reimbursement.

Cardiovascular Stress Testing (CPT Code 93017)

CMS finalized the assignment of CPT 93017 for cardiovascular stress testing to APC 5722 (Level 2 Diagnostic Tests and Related Services) at a rate that reflects a 28 percent cut.

ASNC expressed concern with services that were being added to APC 5722 and the impact it was having on geometric mean costs. CMS responded that geometric mean costs are associated with APC recalibrations necessary to ensure services with similar cost patterns are assigned to the same APC.

Add-on Payment for Tc-99m

CMS finalized a new Healthcare Common Procedure Coding System C-code C9176 (Tc-99m from domestically produced non-HEU Mo-99 [minimum 50 percent], full cost recover add-on, per study dose). The payment rate will be $10. To qualify for the add-on payment, at least 50 percent of the Mo-99 used in the Tc-99m generator must have been domestically produced.

ASNC advocated for the add-on payment because of reported progress on producing Mo-99 domestically. ASNC is encouraged that CMS is cognizant of additional costs associated with U.S. production and supportive of additional reimbursement when domestically sourced Mo-99 becomes available.

Learn More

For more information about the 2026 HOPPS final rule, refer to these CMS resources:

• 2026 Hospital Outpatient Prospective Payment System Final Rule
• 2026 Hospital Outpatient Prospective Payment System Fact Sheet
• CMS Press Release Announcing the 2026 HOPPS Final Rule

In the coming days, ASNC will complete its analysis of the final rule and share details on 2026 reimbursement rates for nuclear cardiology services.

Questions? Email Georgia Lawrence, ASNC’s director of regulatory affairs, at glawrence@asnc.org.

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