The Outpatient Prospective Payment System (OPPS), in the form of Ambulatory Payment Classifications (APCs), is now being significantly changed. The final changes for 2018 continue to involve significantly increased packaging in several forms. Further changes for device dependent APCs along with changes generated to by cost reporting changes. Besides composite APCs, we now have comprehensive APCs. These changes started in 2008 and continue to accelerate with particular attention relative to observation services. Given additional changes for CPT and HCPCS, the impact of changes for APCs are revolutional as opposed to evolutional. Consideration must also be given to how provider‐based clinics are being impacted with the implementation of Section 603 of BiBA 2015.