Policy & oversight
Medicare's Outpatient Payment Advisory Panel Meets Today, Reviewing the Groups That Shape What Patients Pay at the Hospital
The Advisory Panel on Hospital Outpatient Payment holds a public virtual meeting today, August 24, to advise CMS on the clinical accuracy of the payment categories used to set Medicare rates for hospital outpatient services and ambulatory surgery.
By the Goodsurance editorial teamAugust 24, 2026
The Centers for Medicare and Medicaid Services Advisory Panel on Hospital Outpatient Payment is holding a virtual public meeting today, August 24, 2026, from 9:30 a.m. to 5:00 p.m. Eastern time. The meeting is open to the public.
The panel advises the Secretary of Health and Human Services on the clinical integrity of Ambulatory Payment Classification groups, known as APCs. APCs are the payment categories Medicare uses to bundle and reimburse outpatient hospital services, diagnostic tests, and clinic visits. When CMS sets a payment rate for an APC group, Medicare patients in Original Medicare typically owe 20 percent coinsurance after the annual Part B deductible, so how procedures are grouped and priced directly affects what a beneficiary pays for hospital outpatient care.
Medicare's outpatient payment advisory panel meets today to review the cost categories that determine what Original Medicare patients pay for hospital services.
Today's agenda includes reviewing whether procedures grouped within each APC are clinically similar and comparable in resource cost, evaluating how APC group payment weights are calculated, and assessing how supplies and other services are packaged into APC rates. The panel is also scheduled to examine the Inpatient Only list, the set of procedures Medicare currently covers only in a hospital inpatient setting. Removing a procedure from that list allows Medicare to pay for it in an outpatient or ambulatory surgery center, which generally reduces patient cost sharing.
Panel members are appointed by the HHS Secretary. Their recommendations are advisory and do not change policy directly, but CMS routinely incorporates panel guidance into the annual Outpatient Prospective Payment System rule.
In plain words
Today, a group of medical experts is meeting with Medicare officials. They are reviewing the payment categories Medicare uses to set rates for outpatient hospital visits and outpatient surgeries.
These categories are called APCs. When Medicare assigns a service to an APC category and sets a rate, patients on Original Medicare usually pay 20 percent of that rate. How procedures are grouped and priced affects what patients pay at the hospital.
At today's meeting, the experts will look at whether procedures in the same category are truly similar in clinical terms and in cost. They will also review a list of procedures that Medicare currently only pays for during a hospital stay. If a procedure comes off that list, Medicare can pay for it in an outpatient setting, which usually costs patients less.
The experts at this meeting advise CMS but do not make final decisions.
Understand the basics first
Source: Federal Register
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