Finding Medicare Fee-For-Service (FFS)
May 21, 2021
Payment System Rules: Schedules and
Michele L. Malloy
Resources
Research Librarian

The Medicare Fee-For-Service (FFS) program pays physicians, hospitals, and other
health care facilities based on statutorily established payment systems, most of which

are updated annually through regulations. These proposed and final rules follow
schedules based on requirements found in statute, regulation, or both.
As Medicare FFS payment system proposed and final rules are issued, they impact payments received by health
care facilities and providers. Congressional members and committees may comment, and are often contacted by
provider and beneficiary groups. Tracking the status and requirements for specific rules can be onerous, since they
have different schedules and web locations.
This report contains information on these payment system rules in a quick reference table. Specifically, the table
compiles the payment systems, their main portals on the Centers for Medicare & Medicaid Services (CMS)
website, the typical rulemaking schedule, statutory and regulatory requirements, and the most recently issued
proposed rules, public comments, final rules, and subsequent corrections. The table also includes embedded links
to the applicable resources. Not all payment systems include detailed statutory and regulatory requirements, as
noted in the table.
Congressional Research Service

link to page 5 Finding Medicare Fee-For-Service (FFS) Payment System Rules: Schedules and Resource

Introduction
The Medicare Fee-For-Service (FFS) program pays physicians, hospitals, and other health care
facilities based on statutorily established payment systems, most of which are updated annually
through regulations. These proposed and final rules follow schedules based on requirements
found in statute, regulation, or both. Medicare payment systems that follow annual regulatory
updates with comment periods include the following:
 Medicare Physician Fee Schedule Payment (MPFS or PFS),
 Hospital Outpatient Prospective Payment System (OPPS),
 Ambulatory Surgical Center Payment System (ASC Payment System),
 Acute Inpatient Prospective Payment System (IPPS),
 Long-Term Care Hospital Prospective Payment System (LTCH PPS),
 Skilled Nursing Facility Prospective Payment System (SNF PPS),
 Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS),
 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS),
 Home Health Prospective Payment System (Home Health PPS),
 End Stage Renal Disease Prospective Payment System (ESRD PPS), and
 Hospice Wage Index and Payment Rate.
As Medicare FFS payment system proposed and final rules are issued, they impact payments
received by health care facilities and providers. Congressional Members and committees may
comment, and are often contacted by provider and beneficiary groups. Tracking the status and
requirements for specific rules can be onerous, because they have different schedules and web
locations. This report contains information on these payment system rules in a quick reference
table.
To learn more about these payment systems, please see applicable sections of CRS Report
R40425, Medicare Primer. In addition, the Medicare Payment Advisory Commission (MedPAC)
produces Payment Basics,1 a series of brief overviews of how Medicare’s payment systems
function.
Medicare Fee-For-Service Payment System Rules:
Schedules and Resources
Medicare FFS payment system rules and the associated statutory and regulatory requirements
regarding timeline and public comment can be difficult to locate. Table 1 compiles the payment
systems; their main portals on the Centers for Medicare & Medicaid Services (CMS) website; the
typical rulemaking schedule; statutory and regulatory requirements; and the most recently issued
proposed and final rules, including agency docket numbers, Federal Register citations, public
comments available on Regulations.gov, and any corrections issued. The table also includes
embedded links to the applicable resources and notes when rulemaking timelines and comment
periods are not specified. Not all payment systems include detailed statutory and regulatory
requirements, as noted in the table.

1 MedPAC, Payment Basics, at http://medpac.gov/-documents-/payment-basics.
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Table 1. Medicare Fee-For-Service (FFS) Payment System Rules: Schedules and Resources
Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
Payment Policies Under
July-August November
42 USC §1395w-4: Payment for
N/A
2021 Final Rule (12/28/2020)
the Physician Fee
physicians’ services
CMS-1734-F
Schedule
(b)(1) “Before November 1 of
85 FR 84472

the preceding year, for each year
Corrections: 86 FR 5020
Medicare Physician Fee
beginning with 1998, subject to
(1/19/2021) and 86 FR 14690
Schedule Payment (PFS)
subsection (p), the Secretary
(3/18/2021)
shall establish, by regulation, fee
schedules that establish payment

amounts for all physicians'
2021 Proposed Rule
services furnished in all fee
(8/17/2020) CMS-1734-P
schedule areas (as defined in
85 FR 50074
subsection (j)(2)) for the year."
Comments:

Regulations.gov CMS-2020-
Note: public comment is not
0088
addressed broadly for PFS in

statute. However, public
comment is addressed for
2020 Final Rule (11/15/2019)
aspects of the physician payment
CMS-1715-F
system, such as the development
84 FR 62568
of categories and codes.

2020 Proposed Rule
(8/14/2019) CMS-1715-P
84 FR 40482
Comments: Regulations.gov
CMS-2019-0111
Hospital Outpatient
July-August November
42 USC §1395l: Payment of
42 CFR §419.50 Annual review.
2021 Final Rule
Prospective Payment and
-December benefits

(12/29/2020)
Ambulatory Surgical
(t) Prospective payment system
Center Payment Systems
42 CFR §416.130 Publication of revised
CMS-1736-FC
for hospital outpatient
payment methodologies.

department services
85 FR 85866
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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
Hospital Outpatient

"Whenever CMS proposes to revise the
Corrections: 86 FR 11428
Prospective Payment
Note: specific timelines for
payment rate for ASCs, CMS publishes a notice
(2/25/2021)
System (OPPS)
rulemaking and comments are
in the Federal Register describing the revision.

not addressed in statute.
The notice also explains the basis on which the
rates were established. After reviewing public
2021 Proposed Rule
Ambulatory Surgical

comments, CMS publishes a notice establishing
(8/12/2020)
Center (ASC) Payment
42 USC §1395l: Payment of
the rates authorized by this section. In setting
System
CMS-1736-P
benefits
these rates, CMS may adopt reasonable
85 FR 48772
(i) Outpatient surgery
classifications of facilities and may establish
Comments:
“Taking into account the
different rates for different types of surgical
recommendations in the report
procedures."
Regulations.gov CMS-2020-
under section 626(d) of
0090
Medicare Prescription Drug,

Improvement, and Modernization
2020 Final Rule
Act of 2003, the Secretary shall
(11/27/2019)
implement a revised payment
system for payment of surgical
CMS-1717-F2
services furnished in ambulatory
84 FR 65524
surgical centers."

2020 Proposed Rule
Note: specific timelines for
(8/9/2019)
rulemaking and comments
beyond the initial year are not
CMS-1717-P
addressed in statute.
84 FR 39398
Comments: Regulations.gov
CMS-2019-0109
Hospital Inpatient
April-May
August-
42 USC §1395ww: Payments to
42 CFR §412.8 Publication of schedules for
2022 Proposed Rule
Prospective Payment
October
hospitals for inpatient hospital
determining prospective payment rates.
(5/10/2021)
Systems for Acute Care
services
"(b) Annual publication of schedule for
CMS-1752-P
Hospitals and the Long-
(e)(1)(C)(5)
determining prospective payment rates. (1)
Term Care Hospital
86 FR 25070
CMS proposes changes in the methods,
Prospective Payment
“The Secretary shall cause to
amounts, and factors used to determine
Comments: Regulations.gov
System
have published in the Federal
CMS-2021-0070
Register, not later than- (A) the
inpatient prospective payment rates in a
Federal Register document published for public

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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)

April 1 before each fiscal year
comment not later than the April 1 before the
2021 Final Rule
Acute Inpatient
(beginning with fiscal year 1986),
beginning of the Federal fiscal year in which the
(9/18/2020)
Prospective Payment
the Secretary’s proposed
proposed changes would apply.
CMS-1735-F
System (IPPS)
recommendations under
(2) Except as provided in paragraph (c) of this
paragraph (4) for that fiscal year
85 FR 58432

section, CMS publishes a Federal Register
for public comment, and (B) the
document setting forth final methods, amounts,
Corrections: 85 FR 78748

August 1 before such fiscal year
and factors for determining inpatient
(12/7/2020)
Long-Term Care
after such consideration of public prospective payment rates not later than the

Hospital Prospective
comment on the proposal as is
August 1 before the Federal fiscal year in which
Payment System (LTCH
feasible in the time available, the
2021 Proposed Rule
the rates would apply."
PPS)
Secretary's final
(5/29/2020)
recommendations under such

CMS-1735-P
paragraph for that year."
42 CFR §412.535 Publication of the Federal
85 FR 32460

prospective payment rates.
Comments: Regulations.gov
42 USC §1395ww: Payments to
"Except as specified in paragraph (b), CMS
CMS-2020-0052
hospitals for inpatient hospital
publishes information pertaining to the long-

services
term care hospital prospective payment system
effective for each annual update in the Federal
2020 Final Rule (8/16/2019)
(m) Prospective payment for
Register.
long-term care hospitals
CMS-1716-F
(c) For the period beginning on or after

84 FR 42044
October 1, 2009, information on the
Note: specific timelines for
unadjusted Federal payment rates and a

rulemaking and comments for
description of the methodology and data used
2020 Proposed Rule
Long-Term Care Hospital PPS
to calculate the payment rates are published on
(5/3/2019)
are not addressed in statute.
or before August 1 prior to the start of the
CMS-1716-P
Federal fiscal year which begins October 1,
unless for good cause it is published after
84 FR 19158
August 1, but before September 1.
Corrections: 84 FR 28263
(d) Information on the LTC-DRG classification
(6/18/2019)
and associated weighting factors is published on Comments:
or before August 1 prior to the beginning of
Regulations.gov CMS-2019-
each Federal fiscal year."
0073
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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
Prospective Payment
April-May
August
42 USC §1395yy: Payment to
42 CFR §413.345 Publication of Federal
2022 Proposed Rule
System and
skilled nursing facilities for
prospective payment rates.
(4/15/2021)
Consolidated Billing for
routine service costs
"CMS publishes information pertaining to each
CMS- 1746-P
Skilled Nursing Facilities
(e)(4)(H)
update of the Federal payment rates in the
(SNF)
86 FR 19954
“The Secretary shall provide for
Federal Register. This information includes the

Comments: Regulations.gov
publication in the Federal
standardized Federal rates, the resident
CMS-2021-0062
Skilled Nursing Facility
Register, before May 1, 1998
classification system that provides the basis for
Prospective Payment
(with respect to fiscal period
case-mix adjustment, and the factors to be

System (SNF PPS)
described in subparagraph (E)(i))
applied in making the area wage adjustment.
2021 Final Rule
This information is published before May 1 for

and before the August 1
(8/5/2020)
preceding each succeeding fiscal
the fiscal year 1998 and before August 1 for the CMS-1737-F
year (with respect to that
fiscal years 1999 and after."
succeeding fiscal year), of-

85 FR 47594
(i) the unadjusted Federal per

diem rates to be applied to days
2021 Proposed Rule
of covered skilled nursing facility
(4/15/2020)
services furnished during the
CMS-1737-P
fiscal year,
85 FR 20914
(ii) the case mix classification
system to be applied under
Comments: Regulations.gov
subparagraph (G)(i) with respect
CMS-2020-0036
to such services during the fiscal

year, and
2020 Final Rule
(iii) the factors to be applied in
(8/7/2019)
making the area wage adjustment
CMS-1718-F
under subparagraph (G)(ii) with
respect to such services."
84 FR 38728

Note: the timeline for the
2020 Proposed Rule
proposed rule and comments are
(4/25/2019)
not addressed in statute.
CMS-1718-P
84 FR 17620
Comments:
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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
Regulations.gov CMS-2019-
0070
Inpatient Rehabilitation
April-May
August
42 USC §1395ww: Payments to
42 CFR §412.628 Publication of the Federal
2022 Proposed Rule
Facility Prospective
hospitals for inpatient hospital
prospective payment rates.
(4/12/2021)
Payment System
services
"We publish information pertaining to the
CMS-1748-P

(j)(5)
inpatient rehabilitation facility prospective
86 FR 19086
Inpatient Rehabilitation
“The Secretary shall provide for
payment system effective for each fiscal year in
Comments: Regulations.gov
Facility Prospective
publication in the Federal
the Federal Register. This information includes
Payment System (IRF
Register, on or before August 1
the unadjusted Federal payment rates, the
CMS-2021-0057
PPS)
before each fiscal year (beginning
patient classification system and associated

with fiscal year 2001), of the
weighting factors, and a description of the
2021 Final Rule (8/10/2020)
classification and weighting
methodology and data used to calculate the
CMS-1729-F
factors for case mix groups
payment rates. This information is published on
under paragraph (2) for such
or before August 1 prior to the beginning of
85 FR 48424
fiscal year and a description of
each fiscal year."

the methodology and data used
2021 Proposed Rule
in computing the prospective
(4/21/2020)
payment rates under this
subsection for that fiscal year."
CMS-1729-P

85 FR 22065
Note: Only the final rule
Comments: Regulations.gov
deadline is specified, the
CMS-2020-0039
proposed rule is not addressed

in statute. Public comment is not
2020 Final Rule
addressed in statute.
(8/8/2019)
CMS-1710-F
84 FR 39054

2020 Proposed Rule
(4/24/2019)
84 FR 17244
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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
Corrections: 84 FR 24734
(5/29/2019)
Comments:
Regulations.gov CMS-2019-
0066
Inpatient Psychiatric
April-May
August
42 USC §1395ww: Payments to
42 CFR §412.428 Publication of changes to the
2022 Proposed Rule
Facilities Prospective
hospitals for inpatient hospital
inpatient psychiatric facility prospective
(4/13/2021)
Payment System
services
payment system.
CMS-1750-P

(s) Prospective payment for
“CMS will issue annually in the Federal Register
86 FR 19480
Inpatient Psychiatric
psychiatric hospitals
information pertaining to changes to the
Comments: Regulations.gov
Facility Prospective

inpatient psychiatric facility prospective
Payment System (IPF
payment system."
CMS-2021-0060
Note: specific timelines for
PPS)
rulemaking and comments for

Inpatient Psychiatric Facility PPS
2021 Final Rule
are not addressed in statute.
(8/4/2020)
Deadlines for quality measures
CMS-1731-F
are specified.
85 FR 47042
Corrections: 85 FR 52923
(8/27/2020)

2021 Proposed Rule
(4/14/2020)
CMS-1731-P
85 FR 20625
Comments: Regulations.gov
CMS-2020-0035

2020 Final Rule
(8/6/2019)
CMS-1712-F
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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
84 FR 38424

2020 Proposed Rule
(4/23/2019)
CMS-1712-P
84 FR 16948
Comments:
Regulations.gov CMS-2019-
0067
Home Health
July
November
42 USC §1395fff: Prospective
42 CFR §484.225 Annual update of the
2021 Final Rule
Prospective Payment
payment for home health
unadjusted national, standardized prospective
(11/4/2020)
System
services
payment rates.
CMS-1730-F

“CMS annually updates the unadjusted national,
85 FR 70298
Home Health
Note: specific timelines for
standardized prospective payment rate on a
Prospective Payment
rulemaking and comments for
calendar year basis (in accordance with section

System (Home Health
Home Health PPS are not
1895(b)(1)(B) of the Act)."b
2021 Proposed Rule
PPS)
addressed in statute.
(6/30/2020)
CMS-1730-P
85 FR 39408
Corrections: 85 FR 43805
(7/20/2020)
Comments:
Regulations.gov CMS-2020-
0077

2020 Final Rule
(11/8/2019)
CMS-1711-FC
84 FR 60478
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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)

2020 Proposed Rule
(7/18/2019)
CMS-1711-P
84 FR 34598
Comments: Regulations.gov
CMS-2019-0100
End-Stage Renal Disease
July
November
42 USC §1395rr: End stage renal
42 CFR §413.196 Notification of changes in
2021 Final Rule
Prospective Payment
disease program
rate-setting methodologies and payment rates.
(11/9/2020)
System

“(b) Changes in payment rates resulting from
CMS-1732-F

Note: specific timelines for
incorporation of updated cost data or general
85 FR 71398
End Stage Renal Disease
rulemaking and comments for
revisions of geographic labor cost adjustment
Prospective Payment
ESRD PPS are not addressed in
factors are announced by notice published in

System (ESRD PPS)
statute.
the Federal Register without opportunity for
2021 Proposed Rule
prior comment. Revisions of the rate-setting
(7/13/2020)
methodology are published in the Federal
Register in accordance with the Department’s
CMS-1732-P
established rulemaking procedures."
85 FR 42132
Comments:
Regulations.gov CMS-2020-
0079

2020 Final Rule
(11/8/2019)
CMS-1713-F
84 FR 60648

2020 Proposed Rule
(8/6/2019)
CMS-1713-P
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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
84 FR 38330
Comments: Regulations.gov
CMS-2019-0110
Hospice Wage Index and April-May
August
42 USC §1395f: Conditions of
42 CFR §418.306 Annual update of the
2022 Proposed Rule
Payment Rate
and limitations on payment for
payment rates and adjustment for area wage
(4/14/2021)

services
differences.
CMS-1754-P
Hospice Wage Index and
(i) Payment for hospice care
“(b) Annual update of the payment rates. The
86 FR 19700
Payment Rate

payment rates for routine home care and other
services included in hospice care are the
Comments: Regulations.gov
Note: specific timelines for
payment rates in effect under this paragraph
rulemaking and comments for
CMS-2021-0061
during the previous fiscal year increased by the
hospice payment rates are not

hospice payment update percentage increase
addressed in statute.
(as defined in sections1814(i)(1)(C) of the Act),
2021 Final Rule
applicable to discharges occurring in the fiscal
(8/4/2020)
year."b
CMS-1733-F
85 FR 47070

2021 Proposed Rule
(4/15/2020)
CMS-1733-P
85 FR 20949
Comments: Regulations.gov
CMS-2020-0037

2020 Final Rule
(8/6/2019)
CMS-1714-F
84 FR 38484

2020 Proposed Rule
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Rule Name
Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently Issued
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Rule(s)
(4/25/2019)
CMS-1714-P
84 FR 17570
Comments:
Regulations.gov CMS-2019-
0068
Source: Compiled by the Congressional Research Service (CRS).
Notes: Table compiled using the Centers for Medicare & Medicaid Services (CMS), Federal Register, and Regulations.gov. In some cases, although multiple payment
systems are covered by one rule, they are combined here in one row but listed separately. Typical months when proposed and final rules issued can vary, and the months
we list are based on CRS analysis of Federal Register publication dates from the past 10 years. Additionally, corrections are sometimes issued after the final rule.
a. Some Medicare FFS payment systems are not updated through notice and comment or on an annual basis, but only periodically. These include Clinical Laboratory
Fee Schedule, Shared Savings Program, and Ambulance Fee Schedule. Please see the embedded CMS links for more information, including the most recent rules.
b. At times, regulations reference the Social Security Act rather than the U.S. Code citation. The Social Security Administration provides a cross-reference table at
https://www.ssa.gov/OP_Home/comp2/G-APP-H.html.

CRS-11

Finding Medicare Fee-For-Service (FFS) Payment System Rules: Schedules and Resource

Author Information

Michele L. Malloy

Research Librarian

Acknowledgments
CRS Analysts Jim Hahn, Marco Villagrana, and Phoenix Voorhies aided in the compilation and review of
the statutory and regulatory requirements of selected payment system rules.

Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan
shared staff to congressional committees and Members of Congress. It operates solely at the behest of and
under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other
than public understanding of information that has been provided by CRS to Members of Congress in
connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not
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