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Hospital Outpatient Prospective Payment System (OPPS) Based Payment Method
Last Updated: Tuesday, February 10, 2026
Highmark has adopted the Medicare Outpatient Prospective Payment System (OPPS) that is based on the Ambulatory Payment Classification (APC) system and the use of the OPPS components in Highmark APC-based payment methods. Since its inception, the Centers for Medicare and Medicaid Services (CMS) has made, and continues to make, changes and refinements to APCs and the entire OPPS. These changes are made every calendar quarter, with the most significant changes occurring at the start of each calendar year.
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