Finding Medicare Fee-For-Service (FFS)
August 20, 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

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
2022 Proposed Rule
the Physician Fee
physicians’ services
(7/23/2021) CMS-1751-P
Schedule
(b)(1) “Before November 1 of
86 FR 39104

the preceding year, for each year
Comments: Regulations.gov
Medicare Physician Fee
beginning with 1998, subject to
CMS-2021-0119
Schedule Payment (PFS)
subsection (p), the Secretary
shall establish, by regulation, fee

schedules that establish payment
2021 Final Rule
amounts for all physicians'
(12/28/2020) CMS-1734-F
services furnished in all fee
schedule areas (as defined in
85 FR 84472
subsection (j)(2)) for the year."
Corrections: 86 FR 5020

(1/19/2021) and 86 FR 14690
(3/18/2021)
Note: Public comment is not
addressed broadly for PFS in

statute. However, public
2021 Proposed Rule
comment is addressed for
(8/17/2020) CMS-1734-P
aspects of the physician payment
system, such as the development
85 FR 50074
of categories and codes.
Comments: Regulations.gov
CMS-2020-0088

2020 Final Rule
(11/15/2019) CMS-1715-F
84 FR 62568

2020 Proposed Rule
(8/14/2019) CMS-1715-P
84 FR 40482
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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)
Comments: Regulations.gov
CMS-2019-0111
Hospital Outpatient
July-August November
42 USC §1395l: Payment of
42 CFR §419.50 Annual review.
2022 Proposed Rule
Prospective Payment and
-December benefits

(8/4/2021) CMS-1753-P
Ambulatory Surgical
(t) Prospective payment system
Center Payment Systems
42 CFR §416.130 Publication of revised
86 FR 42018
for hospital outpatient
payment methodologies.

department services
Comments: Regulations.gov
"Whenever CMS proposes to revise the
CMS-2021-0124
Hospital Outpatient

payment rate for ASCs, CMS publishes a notice
Prospective Payment

Note: Specific timelines for
in the Federal Register describing the revision.
System (OPPS)
rulemaking and comments are
The notice also explains the basis on which the
2021 Final Rule

not addressed in statute.
rates were established. After reviewing public
(12/29/2020) CMS-1736-FC
Ambulatory Surgical

comments, CMS publishes a notice establishing
85 FR 85866
Center (ASC) Payment
the rates authorized by this section. In setting
42 USC §1395l: Payment of
Corrections: 86 FR 11428
System
these rates, CMS may adopt reasonable
benefits
(2/25/2021)
classifications of facilities and may establish
(i) Outpatient surgery
different rates for different types of surgical

“Taking into account the
procedures."
2021 Proposed Rule
recommendations in the report
(8/12/2020) CMS-1736-P
under section 626(d) of
85 FR 48772
Medicare Prescription Drug,
Improvement, and Modernization
Comments: Regulations.gov
Act of 2003, the Secretary shall
CMS-2020-0090
implement a revised payment

system for payment of surgical
2020 Final Rule
services furnished in ambulatory
surgical centers."
(11/27/2019) CMS-1717-F2

84 FR 65524
Note:Sspecific timelines for

rulemaking and comments
2020 Proposed Rule
beyond the initial year are not
(8/9/2019) CMS-1717-P
addressed in statute.
84 FR 39398
Comments: Regulations.gov
CMS-2019-0109
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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 Inpatient
April-May
August-
42 USC §1395ww: Payments to
42 CFR §412.8 Publication of schedules for
2022 Final Rule
Prospective Payment
October
hospitals for inpatient hospital
determining prospective payment rates.
(8/13/2021) CMS-1752-F
Systems for Acute Care
services
"(b) Annual publication of schedule for
Hospitals and the Long-
86 FR 44774
(e)(1)(C)(5)
determining prospective payment rates. (1)
Term Care Hospital
CMS proposes changes in the methods,

Prospective Payment
“The Secretary shall cause to
amounts, and factors used to determine
2022 Proposed Rule
System
have published in the Federal
Register, not later than- (A) the
inpatient prospective payment rates in a
(5/10/2021) CMS-1752-P

April 1 before each fiscal year
Federal Register document published for public
86 FR 25070
Acute Inpatient
(beginning with fiscal year 1986),
comment not later than the April 1 before the
Corrections: 86 FR 33157
Prospective Payment
the Secretary’s proposed
beginning of the Federal fiscal year in which the
(6/24/2021)
System (IPPS)
recommendations under
proposed changes would apply.
Comments: Regulations.gov

paragraph (4) for that fiscal year
(2) Except as provided in paragraph (c) of this
for public comment, and (B) the
section, CMS publishes a Federal Register
CMS-2021-0070

August 1 before such fiscal year
document setting forth final methods, amounts,

Long-Term Care
after such consideration of public and factors for determining inpatient
2021 Final Rule
Hospital Prospective
comment on the proposal as is
prospective payment rates not later than the
Payment System (LTCH
feasible in the time available, the
August 1 before the Federal fiscal year in which
(9/18/2020) CMS-1735-F
PPS)
Secretary's final
the rates would apply."
85 FR 58432
recommendations under such

Corrections: 85 FR 78748
paragraph for that year."
42 CFR §412.535 Publication of the Federal
(12/7/2020)

prospective payment rates.

42 USC §1395ww: Payments to
"Except as specified in paragraph (b), CMS
2021 Proposed Rule
hospitals for inpatient hospital
publishes information pertaining to the long-
(5/29/2020) CMS-1735-P
services
term care hospital prospective payment system
85 FR 32460
(m) Prospective payment for
effective for each annual update in the Federal
long-term care hospitals
Register.
Comments: Regulations.gov
CMS-2020-0052

(c) For the period beginning on or after

Note: Specific timelines for
October 1, 2009, information on the
rulemaking and comments for
unadjusted Federal payment rates and a
2020 Final Rule
Long-Term Care Hospital PPS
description of the methodology and data used
(8/16/2019) CMS-1716-F
are not addressed in statute.
to calculate the payment rates are published on
or before August 1 prior to the start of the
84 FR 42044
Federal fiscal year which begins October 1,

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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)
unless for good cause it is published after
2020 Proposed Rule
August 1, but before September 1.
(5/3/2019) CMS-1716-P
(d) Information on the LTC-DRG classification
84 FR 19158
and associated weighting factors is published on
or before August 1 prior to the beginning of
Corrections: 84 FR 28263
each Federal fiscal year."
(6/18/2019)
Comments: Regulations.gov
CMS-2019-0073
Prospective Payment
April-May
August
42 USC §1395yy: Payment to
42 CFR §413.345 Publication of Federal
2022 Final Rule
System and
skilled nursing facilities for
prospective payment rates.
(8/4/2021) CMS-1746-F
Consolidated Billing for
routine service costs
"CMS publishes information pertaining to each
Skilled Nursing Facilities
86 FR 42424
(e)(4)(H)
update of the Federal payment rates in the
(SNF)

“The Secretary shall provide for
Federal Register. This information includes the

publication in the Federal
standardized Federal rates, the resident
2022 Proposed Rule
Skilled Nursing Facility
Register, before May 1, 1998
classification system that provides the basis for
(4/15/2021) CMS- 1746-P
Prospective Payment
(with respect to fiscal period
case-mix adjustment, and the factors to be
86 FR 19954
System (SNF PPS)
described in subparagraph (E)(i))
applied in making the area wage adjustment.
Comments: Regulations.gov
and before the August 1
This information is published before May 1 for
CMS-2021-0062
preceding each succeeding fiscal
the fiscal year 1998 and before August 1 for the
year (with respect to that
fiscal years 1999 and after."

succeeding fiscal year), of-
2021 Final Rule
(i) the unadjusted Federal per
(8/5/2020) CMS-1737-F
diem rates to be applied to days
85 FR 47594
of covered skilled nursing facility
services furnished during the

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

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

Note: The timeline for the
2020 Proposed Rule
proposed rule and comments are
not addressed in statute.
(4/25/2019) CMS-1718-P
84 FR 17620
Comments: Regulations.gov
CMS-2019-0070
Inpatient Rehabilitation
April-May
August
42 USC §1395ww: Payments to
42 CFR §412.628 Publication of the Federal
2022 Final Rule
Facility Prospective
hospitals for inpatient hospital
prospective payment rates.
(8/4/2021) CMS-1748-F
Payment System
services
"We publish information pertaining to the
86 FR 42362

(j)(5)
inpatient rehabilitation facility prospective

Inpatient Rehabilitation
“The Secretary shall provide for
payment system effective for each fiscal year in
Facility Prospective
publication in the Federal
the Federal Register. This information includes
2022 Proposed Rule
Payment System (IRF
Register, on or before August 1
the unadjusted Federal payment rates, the
(4/12/2021) CMS-1748-P
PPS)
before each fiscal year (beginning
patient classification system and associated
86 FR 19086
with fiscal year 2001), of the
weighting factors, and a description of the
Comments: Regulations.gov
classification and weighting
methodology and data used to calculate the
factors for case mix groups
payment rates. This information is published on
CMS-2021-0057
under paragraph (2) for such
or before August 1 prior to the beginning of

fiscal year and a description of
each fiscal year."
2021 Final Rule
the methodology and data used
in computing the prospective
(8/10/2020) CMS-1729-F
payment rates under this
85 FR 48424
subsection for that fiscal year."

2021 Proposed Rule
Note: Only the final rule
(4/21/2020) CMS-1729-P
deadline is specified, the
85 FR 22065
proposed rule is not addressed
in statute. Public comment is not
Comments: Regulations.gov
addressed in statute.
CMS-2020-0039

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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 Final Rule
(8/8/2019) CMS-1710-F
84 FR 39054

2020 Proposed Rule
(4/24/2019) CMS-1710-P
84 FR 17244
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 Final Rule
Facilities Prospective
hospitals for inpatient hospital
inpatient psychiatric facility prospective
(8/4/2021) CMS-1750-F
Payment System
services
payment system.
86 FR 42608

(s) Prospective payment for
“CMS will issue annually in the Federal Register

Inpatient Psychiatric
psychiatric hospitals
information pertaining to changes to the
Facility Prospective

inpatient psychiatric facility prospective
2022 Proposed Rule
Payment System (IPF
payment system."
Note: specific timelines for
(4/13/2021) CMS-1750-P
PPS)
rulemaking and comments for
86 FR 19480
Inpatient Psychiatric Facility PPS
Comments: Regulations.gov
are not addressed in statute.
CMS-2021-0060
Deadlines for quality measures
are specified.

2021 Final Rule
(8/4/2020) CMS-1731-F
85 FR 47042
Corrections: 85 FR 52923
(8/27/2020)

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

2020 Final Rule
(8/6/2019) CMS-1712-F
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
2022 Proposed Rule
Prospective Payment
payment for home health
unadjusted national, standardized prospective
(7/7/2021) CMS-1747-P
System
services
payment rates.
86 FR 35874

“CMS annually updates the unadjusted national,
Comments: Regulations.gov
Home Health
Note: Specific timelines for
standardized prospective payment rate on a
CMS-2021-0112
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
PPS)
addressed in statute.
2021 Final Rule
(11/4/2020) CMS-1730-F
85 FR 70298

2021 Proposed Rule
(6/30/2020) CMS-1730-P
85 FR 39408
Corrections: 85 FR 43805
(7/20/2020)
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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)
Comments: Regulations.gov
CMS-2020-0077

2020 Final Rule
(11/8/2019) CMS-1711-FC
84 FR 60478

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
2022 Proposed Rule
Prospective Payment
disease program
rate-setting methodologies and payment rates.
(7/9/2021) CMS-1749-P
System

“(b) Changes in payment rates resulting from
86 FR 36322

Note: Specific timelines for
incorporation of updated cost data or general
Comments: Regulations.gov
End Stage Renal Disease
rulemaking and comments for
revisions of geographic labor cost adjustment
CMS-2021-0114
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
prior comment. Revisions of the rate-setting
2021 Final Rule
methodology are published in the Federal
(11/9/2020) CMS-1732-F
Register in accordance with the Department’s
85 FR 71398
established rulemaking procedures."

2021 Proposed Rule
(7/13/2020) CMS-1732-P
85 FR 42132
Comments: Regulations.gov
CMS-2020-0079

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

2020 Proposed Rule
(8/6/2019) CMS-1713-P
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 Final Rule
Payment Rate
and limitations on payment for
payment rates and adjustment for area wage
(8/4/2021) CMS-1754-F

services
differences.
86 FR 42528
Hospice Wage Index and
(i) Payment for hospice care
“(b) Annual update of the payment rates. The

Payment Rate

payment rates for routine home care and other
services included in hospice care are the
2022 Proposed Rule
Note: Specific timelines for
payment rates in effect under this paragraph
rulemaking and comments for
(4/14/2021) CMS-1754-P
during the previous fiscal year increased by the
hospice payment rates are not
86 FR 19700
hospice payment update percentage increase
addressed in statute.
(as defined in sections1814(i)(1)(C) of the Act),
Comments: Regulations.gov
applicable to discharges occurring in the fiscal
CMS-2021-0061
year."b

2021 Final Rule
(8/4/2020) CMS-1733-F
85 FR 47070

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

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

2020 Proposed Rule
(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 Centers for Medicare & Medicaid Services (CMS) websites, 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 are 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

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
subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in
its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or
material from a third party, you may need to obtain the permission of the copyright holder if you wish to
copy or otherwise use copyrighted material.

Congressional Research Service
R46797 · VERSION 3 · UPDATED
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