2026 Medicare OPPS Final Ruling Resources

Kathleen walks hospital-owned outpatient wound and ulcer management teams through the OPPS Final Rule for 2026, clarifying how CMS turns policy into payment via APC groupings and where to locate the official national rates in Addendum A (by APC) and Addendum B (by HCPCS). She details the headline changes for CTPs: unpackaging products from the application procedures, eliminating high/low cost tiers, establishing a single OPPS product rate of $127.14 per cm² (not geographically adjusted), and standardizing application reporting with 15271–15278. The episode also flags what does not change—non-sheet products won’t be separately paid under OPPS in 2026—and underscores that published rates don’t guarantee coverage; LCDs, MAC policies, and airtight medical necessity documentation still rule. Looking ahead, Kathleen notes that after 2026, CTPs will be grouped by FDA regulatory status (e.g., PMA, 510(k), 361 HCT/P) with payment details to follow, and she highlights a key win for large foot ulcers, which will now be paid at parity with large leg ulcers—opening the door for better access to care.