Finding Medicare Fee-For-Service (FFS)
December 19, 2022
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 https://www.medpac.gov/document-type/payment-basic/.
Congressional Research Service

1

link to page 18
Table 1. Medicare Fee-For-Service (FFS) Payment System Rules: Schedules and Resources

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Payment Policies Under the July-August November
42 USC §1395w-4: Payment for
N/A
2023 Final Rule
Physician Fee Schedule
physicians’ services
(11/18/2022) CMS-1770-F

(b)(1) “Before November 1 of
87 FR 69404
Medicare Physician Fee
the preceding year, for each year

Schedule Payment (PFS)
beginning with 1998, subject to
subsection (p), the Secretary
2023 Proposed Rule
shall establish, by regulation, fee
(7/29/2022) CMS-1770-P
schedules that establish payment
87 FR 45860
amounts for all physicians'
services furnished in all fee
Comments: Regulations.gov
schedule areas (as defined in
CMS-2022-0113
subsection (j)(2)) for the year."

2022 Final Rule
Note: Public comment is not
(11/19/2021) CMS-1751-F
addressed broadly for PFS in
statute. However, public
86 FR 64996
comment is addressed for

aspects of the physician payment
2022 Proposed Rule
system, such as the development
(7/23/2021) CMS-1751-P
of categories and codes.
86 FR 39104
Comments: Regulations.gov
CMS-2021-0119

2021 Final Rule
(12/28/2020) CMS-1734-F
85 FR 84472
Corrections: 86 FR 5020
(1/19/2021) and 86 FR 14690
(3/18/2021)

CRS-2

link to page 18

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
2021 Proposed Rule
(8/17/2020) CMS-1734-P
85 FR 50074
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
Comments: Regulations.gov
CMS-2019-0111
Hospital Outpatient
July-August November
42 USC §1395l: Payment of
42 CFR §419.50 Annual review.
2023 Final Rule
Prospective Payment and
-December benefits

(11/23/2022) CMS-1772-FC
Ambulatory Surgical
(t) Prospective payment system
Center Payment Systems
42 CFR §416.130 Publication of revised
87 FR 71748
for hospital outpatient
payment methodologies.

department services

"Whenever CMS proposes to revise the
Hospital Outpatient

2023 Proposed Rule
payment rate for ASCs, CMS publishes a notice
Prospective Payment
Note: Specific timelines for
in the Federal Register describing the revision.
(7/26/2022) CMS-1772-P
System (OPPS)
rulemaking and comments are
The notice also explains the basis on which the
87 FR 44502

not addressed in statute.
rates were established. After reviewing public
Comments: Regulations.gov
Ambulatory Surgical

comments, CMS publishes a notice establishing
CMS-2022-0118
Center (ASC) Payment
the rates authorized by this section. In setting
42 USC §1395l: Payment of

System
these rates, CMS may adopt reasonable
benefits
classifications of facilities and may establish
2022 Final Rule
(i) Outpatient surgery
different rates for different types of surgical
(11/16/2021) CMS-1753-FC
“Taking into account the
procedures."
86 FR 63458
recommendations in the report
CRS-3

link to page 18

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
under section 626(d) of

Medicare Prescription Drug,
2022 Proposed Rule
Improvement, and Modernization
Act of 2003, the Secretary shall
(8/4/2021) CMS-1753-P
implement a revised payment
86 FR 42018
system for payment of surgical
Comments: Regulations.gov
services furnished in ambulatory
CMS-2021-0124
surgical centers."

2021 Final Rule
Note: Specific timelines for
(12/29/2020) CMS-1736-FC
rulemaking and comments
beyond the initial year are not
85 FR 85866
addressed in statute.
Corrections: 86 FR 11428
(2/25/2021)

2021 Proposed Rule
(8/12/2020) CMS-1736-P
85 FR 48772
Comments: Regulations.gov
CMS-2020-0090

2020 Final Rule
(11/27/2019) CMS-1717-F2
84 FR 65524

2020 Proposed Rule
(8/9/2019) CMS-1717-P
84 FR 39398
Comments: Regulations.gov
CMS-2019-0109
CRS-4

link to page 18

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Hospital Inpatient
April-May
August-
42 USC §1395ww: Payments to
42 CFR §412.8 Publication of schedules for
2023 Final Rule
Prospective Payment
October
hospitals for inpatient hospital
determining prospective payment rates.
(8/10/2022) CMS-1771-F
Systems for Acute Care
services
"(b) Annual publication of schedule for
Hospitals and the Long-
87 FR 48780
(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
2023 Proposed Rule
System
have published in the Federal
Register, not later than- (A) the
inpatient prospective payment rates in a
(5/10/2022) CMS-1771-P

April 1 before each fiscal year
Federal Register document published for public
87 FR 28108
Acute Inpatient
(beginning with fiscal year 1986),
comment not later than the April 1 before the
Comments: Regulations.gov
Prospective Payment
the Secretary’s proposed
beginning of the Federal fiscal year in which the
CMS-2022-0074
System (IPPS)
recommendations under
proposed changes would apply.

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
2022 Final Rule
Long-Term Care Hospital
August 1 before such fiscal year
document setting forth final methods, amounts,
Prospective Payment
(8/13/2021) CMS-1752-F
after such consideration of public and factors for determining inpatient
System (LTCH PPS)
comment on the proposal as is
prospective payment rates not later than the
86 FR 44774
feasible in the time available, the
August 1 before the Federal fiscal year in which

Secretary's final
the rates would apply."
2022 Proposed Rule
recommendations under such

(5/10/2021) CMS-1752-P
paragraph for that year."
42 CFR §412.535 Publication of the Federal
86 FR 25070

prospective payment rates.
Corrections: 86 FR 33157
42 USC §1395ww: Payments to
"Except as specified in paragraph (b), CMS
(6/24/2021)
hospitals for inpatient hospital
publishes information pertaining to the long-
services
Comments: Regulations.gov
term care hospital prospective payment system
CMS-2021-0070
(m) Prospective payment for
effective for each annual update in the Federal
long-term care hospitals
Register.

(c) For the period beginning on or after
2021 Final Rule
Note: Specific timelines for
October 1, 2009, information on the
(9/18/2020) CMS-1735-F
rulemaking and comments for
unadjusted Federal payment rates and a
85 FR 58432
Long-Term Care Hospital PPS
description of the methodology and data used
Corrections: 85 FR 78748
are not addressed in statute.
to calculate the payment rates are published on
or before August 1 prior to the start of the
(12/7/2020)
Federal fiscal year which begins October 1,

CRS-5

link to page 18

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
unless for good cause it is published after
2021 Proposed Rule
August 1, but before September 1.
(5/29/2020) CMS-1735-P
(d) Information on the LTC-DRG classification
85 FR 32460
and associated weighting factors is published on
or before August 1 prior to the beginning of
Comments: Regulations.gov
each Federal fiscal year."
CMS-2020-0052

2020 Final Rule
(8/16/2019) CMS-1716-F
84 FR 42044

2020 Proposed Rule
(5/3/2019) CMS-1716-P
84 FR 19158
Corrections: 84 FR 28263
(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
2023 Final Rule
System and Consolidated
skil ed nursing facilities for
prospective payment rates.
(8/3/2022) CMS-1765-F
Bil ing for Skil ed Nursing
routine service costs
"CMS publishes information pertaining to each
Facilities (SNF)
87 FR 47502
(e)(4)(H)
update of the Federal payment rates in the

“The Secretary shall provide for
Federal Register. This information includes the
Skil ed Nursing Facility
publication in the Federal
standardized Federal rates, the resident
2023 Proposed Rule
Prospective Payment
Register, before May 1, 1998
classification system that provides the basis for
(4/15/2022) CMS-1765-P
System (SNF PPS)
(with respect to fiscal period
case-mix adjustment, and the factors to be
87 FR 22720
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
preceding each succeeding fiscal
the fiscal year 1998 and before August 1 for the CMS-2022-0069
year (with respect to that
fiscal years 1999 and after."

succeeding fiscal year), of-
2022 Final Rule
CRS-6

link to page 18

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
(i) the unadjusted Federal per
(8/4/2021) CMS-1746-F
diem rates to be applied to days
86 FR 42424
of covered skil ed nursing facility
services furnished during the

fiscal year,
2022 Proposed Rule
(i ) the case mix classification
(4/15/2021) CMS- 1746-P
system to be applied under
86 FR 19954
subparagraph (G)(i) with respect
Comments: Regulations.gov
to such services during the fiscal
CMS-2021-0062
year, and

(i i) the factors to be applied in
making the area wage adjustment
2021 Final Rule
under subparagraph (G)(i ) with
(8/5/2020) CMS-1737-F
respect to such services."
85 FR 47594

Note: The timeline for the
2021 Proposed Rule
proposed rule and comments are
not addressed in statute.
(4/15/2020) CMS-1737-P
85 FR 20914
Comments: Regulations.gov
CMS-2020-0036

2020 Final Rule
(8/7/2019) CMS-1718-F
84 FR 38728

2020 Proposed Rule
(4/25/2019) CMS-1718-P
84 FR 17620
Comments: Regulations.gov
CMS-2019-0070
CRS-7

link to page 18

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Comments: Regulations.gov
CMS-2020-0039

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
2023 Final Rule
Facilities Prospective
hospitals for inpatient hospital
inpatient psychiatric facility prospective
(7/29/2022) CMS-1769-F
Payment System
services
payment system.
87 FR 46846

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

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

inpatient psychiatric facility prospective
2023 Proposed Rule
System (IPF PPS)
payment system."
Note: specific timelines for
(4/4/2022) CMS-1769-P
rulemaking and comments for
87 FR 19415
Inpatient Psychiatric Facility PPS
Comments: Regulations.gov
are not addressed in statute.
CMS-2022-0062
Deadlines for quality measures
are specified.

2022 Final Rule
(8/4/2021) CMS-1750-F
86 FR 42608

CRS-9

link to page 18

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
2022 Proposed Rule
(4/13/2021) CMS-1750-P
86 FR 19480
Comments: Regulations.gov
CMS-2021-0060

2021 Final Rule
(8/4/2020) CMS-1731-F
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
84 FR 38424

2020 Proposed Rule
(4/23/2019) CMS-1712-P
84 FR 16948
Comments: Regulations.gov
CMS-2019-0067
CRS-10

link to page 18 link to page 18

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Home Health Prospective
July
November
42 USC §1395fff: Prospective
42 CFR §484.225 Annual update of the
2023 Final Rule
Payment System
payment for home health
unadjusted national, standardized prospective
(11/4/2022) CMS-1766-F

services
payment rates.
87 FR 66790
Home Health Prospective

“CMS annually updates the unadjusted national,

Payment System (Home
Note: Specific timelines for
standardized prospective payment rate on a
Health PPS)
rulemaking and comments for
calendar year basis (in accordance with section
2023 Proposed Rule
Home Health PPS are not
1895(b)(1)(B) of the Act)."b
(6/23/2022) CMS-1766-P
addressed in statute.
87 FR 37600
Comments: Regulations.gov
CMS-2022-0109

2022 Final Rule
(11/9/2021) CMS-1747-F
86 FR 62240

2022 Proposed Rule
(7/7/2021) CMS-1747-P
86 FR 35874
Comments: Regulations.gov
CMS-2021-0112

2021 Final Rule
(11/4/2020) CMS-1730-F
85 FR 70298

2021 Proposed Rule
(6/30/2020) CMS-1730-P
85 FR 39408
CRS-11

link to page 18

Typically Issued
Requirements: Timeline and Public Comment

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

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
2023 Final Rule
Prospective Payment
disease program
rate-setting methodologies and payment rates.
(11/7/2022) CMS-1768-F
System

“(b) Changes in payment rates resulting from
87 FR 67136

Note: Specific timelines for
incorporation of updated cost data or general

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
2023 Proposed Rule
System (ESRD PPS)
statute.
the Federal Register without opportunity for
(6/28/2022) CMS-1768-P
prior comment. Revisions of the rate-setting
87 FR 38464
methodology are published in the Federal
Register in accordance with the Department’s
Comments: Regulations.gov
established rulemaking procedures."
CMS-2022-0110

2022 Final Rule
(11/8/2021) CMS-1749-F
86 FR 61874
CRS-12

link to page 18

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Corrections: 86 FR 70982
(12/14/2021)

2022 Proposed Rule
(7/9/2021) CMS-1749-P
86 FR 36322
Comments: Regulations.gov
CMS-2021-0114

2021 Final Rule
(11/9/2020) CMS-1732-F
85 FR 71398

2021 Proposed Rule
(7/13/2020) CMS-1732-P
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
84 FR 38330
Comments: Regulations.gov
CMS-2019-0110
CRS-13

link to page 18 link to page 18

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Hospice Wage Index and
April-May
August
42 USC §1395f: Conditions of
42 CFR §418.306 Annual update of the
2023 Final Rule
Payment Rate
and limitations on payment for
payment rates and adjustment for area wage
(7/29/2022) CMS-1773-F

services
differences.
87 FR 45669
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
2023 Proposed Rule
Note: Specific timelines for
payment rates in effect under this paragraph
rulemaking and comments for
(4/4/2022) CMS-1773-P
during the previous fiscal year increased by the
hospice payment rates are not
87 FR 19442
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-2022-0060
year."b

2022 Final Rule
(8/4/2021) CMS-1754-F
86 FR 42528

2022 Proposed Rule
(4/14/2021) CMS-1754-P
86 FR 19700
Comments: Regulations.gov
CMS-2021-0061

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

2021 Proposed Rule
(4/15/2020) CMS-1733-P
85 FR 20949
CRS-14

link to page 18

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Comments: Regulations.gov
CMS-2020-0037

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-15

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 10 · UPDATED
16