--- title: "APC, Ambulatory Payment Classification | MedTech Terms" description: "The Medicare grouping system that determines hospital outpatient payment amounts under OPPS, analogous to MS-DRGs for inpatient." lang: en json-ld: | { "@context": "https://schema.org", "@graph": [ { "@type": "DefinedTerm", "@id": "https://medtechterms.com/terms/apc#term", "name": "Ambulatory Payment Classification", "alternateName": "APC", "description": "Ambulatory Payment Classifications (APCs) are the unit of payment under the Medicare Hospital Outpatient Prospective Payment System (OPPS), established by the Balanced Budget Act of 1997 and effective August 2000. 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[Home](/) 2. / 3. [Terms](/terms) 4. / 5. [Reimbursement](/terms?cat=Reimbursement) 6. / 7. Ambulatory Payment Classification [All terms](/terms) Reimbursement [Hospital Buyer & Reimbursement](/ecosystems/hospital-buyer)APC # Ambulatory Payment Classification The Medicare grouping system that determines hospital outpatient payment amounts under OPPS, analogous to MS-DRGs for inpatient. Reviewed by [Christian Espinosa, Founder, Blue Goat Cyber](/authors/christian-espinosa) Last reviewed May 9, 2026 ## Definition Ambulatory Payment Classifications (APCs) are the unit of payment under the Medicare Hospital [Outpatient Prospective Payment System](/terms/opps) (OPPS), established by the Balanced Budget Act of 1997 and effective August 2000. CMS groups outpatient procedures with similar clinical characteristics and resource use into APCs and pays a single bundled amount per APC, with status indicators that determine whether the service is separately payable, packaged into another APC, or excluded. What the regulation says [OPPS](/terms/opps) rules are issued annually in the OPPS Final Rule (calendar-year cycle). 42 CFR 419 governs the system. CMS publishes the APC list and status indicators in OPPS Addendum B. ## What this means in practice APC assignment plus pass-through status ( [TPT](/terms/tpt)) determines the outpatient economics of a new device. Many MedTech launch strategies hinge on securing a favorable APC and, where eligible, transitional pass-through payment. Common pitfalls - • Assuming an inpatient NTAP equivalent exists in OPPS, it does not; the outpatient analog is TPT. - • Missing the annual OPPS comment window (June-September) for APC reassignment requests. ## Related terms Grouped by theme ### Editor's picks · Hand-selected related concepts [ Reimbursement Inpatient Prospective Payment System(IPPS) Medicare's payment system for inpatient hospital stays. ](/terms/ipps)[ Reimbursement MS-DRG(MS-DRG) Medicare's inpatient hospital payment classification system. ](/terms/ms-drg)[ Reimbursement New Technology Add-On Payment(NTAP) Supplemental Medicare payment for inpatient use of qualifying new technologies. ](/terms/ntap)[ Reimbursement Outpatient Prospective Payment System(OPPS) Medicare's payment system for hospital outpatient services. ](/terms/opps) ### More in Reimbursement · Same category [ Reimbursement Transitional Pass-Through Payment(TPT) Supplemental outpatient payment for new device technologies. ](/terms/tpt)[ Reimbursement 340B Drug Pricing Program(340B) Federal program providing discounted drugs to safety-net providers. ](/terms/340b)[ Reimbursement ASC Site-of-Service Shift Migration of procedures from hospitals to ambulatory surgery centers. ](/terms/asc-shift)[ Reimbursement Budget Impact Model(BIM) Financial model that estimates the total cost consequences of adopting a new technology to a payer's budget over a defined horizon. ](/terms/budget-impact-model) Cited by Where this term appears across MedTech Terms. Ecosystems (1) - [Hospital Buyer & Reimbursement](/ecosystems/hospital-buyer) ## Primary references 3 sources Link health: 3 verified · last checked 2026-06-20 CMS· 1 eCFR· 1 AMA· 1 1. [1 CMS, Hospital OPPS Verified CMS · cms.gov ](https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient) 2. [2 42 CFR 419 Verified eCFR · ecfr.gov ](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-419) 3. [3 AMA CPT Resources Verified AMA · ama-assn.org ](https://www.ama-assn.org/practice-management/cpt) Inline markers like \[1\] jump to the matching reference above. Sponsor note ### Need cybersecurity expertise on a connected-device launch? Blue Goat Cyber helps MedTech teams ship connected products that hospital security teams will actually procure. [Book a 30-minute discovery session](https://go.bluegoatcyber.com/meetings/blue-goat-cyber/discovery-session) - No obligation - Expert-led from minute one - NDA available on request MedTech Terms is a community resource sponsored by [Blue Goat Cyber](https://bluegoatcyber.com). Definitions are independent of any vendor. On this term Category Reimbursement Acronym APC Sources 3 Updated 5/9/2026 [Compare with another term](/compare?a=apc) Learn in 60 seconds Card Lesson Quiz The Medicare grouping system that determines hospital outpatient payment amounts under OPPS, analogous to MS-DRGs for inpatient. - · APC assignment plus pass-through status (TPT) determines the outpatient economics of a new device. - · Many MedTech launch strategies hinge on securing a favorable APC and, where eligible, transitional pass-through payment. Remember this Watch out: Assuming an inpatient NTAP equivalent exists in OPPS, it does not; the outpatient analog is TPT. Related terms - [Outpatient Prospective Payment System(OPPS) ](/terms/opps) - [Transitional Pass-Through Payment(TPT) ](/terms/tpt) - [MS-DRG(MS-DRG) ](/terms/ms-drg) - [New Technology Add-On Payment(NTAP) ](/terms/ntap) - [Inpatient Prospective Payment System(IPPS) ](/terms/ipps) You may also need Auto-suggested from Reimbursement and shared keywords. - [Site-Neutral Payment ](/terms/site-neutral-payment) - [Bundled Payment ](/terms/bundled-payment) - [CMS IDE Coverage (Category A & B) ](/terms/ide-coverage) - [LCD and NCD ](/terms/lcd-ncd) - [ASC Site-of-Service Shift ](/terms/asc-shift) - [Budget Impact Model(BIM) ](/terms/budget-impact-model) [All Reimbursement terms](/terms?cat=Reimbursement) MedTech Terms An authoritative, plain-language reference for the regulatory, quality, cybersecurity, and software terms that shape modern medical devices. Browse - [All terms](/terms) - [A–Z index](/a-z) - [Categories](/categories) - [Ecosystems](/ecosystems) - [Learning paths](/paths) - [Compare terms](/compare) - [Quiz](/quiz) Resources - [FDA Medical Devices](https://www.fda.gov/medical-devices) - [EU MDR](https://eur-lex.europa.eu/eli/reg/2017/745/oj) - [IMDRF](https://www.imdrf.org/) - [Methodology](/methodology) - [Changelog](/changelog) - [Editor: Christian Espinosa](/authors/christian-espinosa) - [About this site](/about) © 2026 MedTech Terms. Reference content for educational purposes - not regulatory advice. A community resource sponsored by [Blue Goat Cyber](https://bluegoatcyber.com)