SUS Table update: what has changed

The financial sustainability of hospitals that serve Brazil’s Unified Health System (SUS) is one of the most urgent issues in Brazilian hospital management. At the center of this issue is the SUS Table, the official reference for the amounts the federal government pays to public, private and philanthropic institutions that provide services to the public system.

For more than a decade, this table remained frozen. The last broad revision had taken place in 2013, and payments became increasingly insufficient in the face of hospital cost inflation. It was in this context that Law No. 14,820/2024 was signed, establishing for the first time a mechanism for mandatory annual revision of the amounts.

Since then, two developments have marked the law’s implementation: the publication of Ordinances GM/MS No. 6,464 and No. 6,465, on December 30, 2024, which put the first adjustments into effect.

What the SUS Table is and why it is critical for philanthropic hospitals

The SUS Table, the informal name for the SUS Table of Procedures, Drugs, Orthotics, Prosthetics and Special Materials, is the official instrument that sets the amounts the federal government pays to hospitals, clinics and other providers contracted by the public system. It is managed by the Ministry of Health and operated through SIGTAP (Procedure Table Management System). In it, each procedure has a code, a description and a reference amount.

For hospitals that serve SUS, this table directly determines the revenue the institution will receive for each hospital stay, surgery, test or appointment performed. When the amounts are outdated, the hospital provides the care, bears the real cost and receives a payment that does not cover the expense.

The impact is most severe on philanthropic entities (Santas Casas de Misericórdia, evangelical hospitals and other nonprofit institutions). According to the Confederação das Santas Casas de Misericórdia, Hospitais e Entidades Filantrópicas (CMB), these institutions account for about 70% of the high-complexity procedures performed by SUS nationwide. In more than 900 Brazilian municipalities, the philanthropic hospital is the only healthcare facility available to the population.

That is why any change to the SUS Table has direct consequences not only for the financial balance of these institutions, but for the population’s access to medium- and high-complexity healthcare services.

The historical lag: numbers that explain the crisis

The SUS Table lag is not a recent problem. The last broad revision of the amounts took place in 2013, and in the years that followed, payments were eroded by inflation without any proportional correction. The cumulative result is a significant gap between what the government pays and what procedures actually cost.

According to the CMB, the current lag exceeds 60% of the real value of procedures. This means that for every R$ 100 spent providing a service to SUS, the hospital gets less than R$ 40 back. To keep their doors open, philanthropic entities turned to debt: at Caixa Econômica Federal alone, the sector has accumulated about R$ 8 billion in debt, at a cost of R$ 150 million a month in interest alone.

In total, more than 1,500 SUS Table procedures are outdated, according to data from the Ministry of Health’s SUS Hospital Information System (SIH/SUS). This volume explains why one-off adjustments, however welcome, do not solve the structural problem of public hospital financing in Brazil.

What Law No. 14,820/2024 established

Signed in early 2024, Law No. 14,820/2024 was an important institutional step forward: for the first time, Brazil had a legal mechanism requiring the annual revision of the amounts SUS pays to philanthropic and nonprofit entities.

The law requires the Ministry of Health to set, every December, the adjustment rate to be applied the following year. The stated goal is to ensure the quality of the services provided, the economic and financial balance of the institutions and the preservation of the real value of payments over time.

Implementing the law involved an initial R$ 1 billion strategy, divided into two components. The first was a flat 3.5% adjustment on funding for the specialized care of philanthropic entities, totaling R$ 593.4 million distributed proportionally among the institutions.

The second provided for updating the table for strategic specialties (vascular, oncological and orthopedic surgery), with an average increase of more than 320% for these procedures.

The December 2024 ordinances: what was put into effect

On December 30, 2024, the Ministry of Health published two ordinances that formalized the first adjustment provided for by the law, both effective immediately.

• Ordinance GM/MS No. 6,464 applied the 3.5% adjustment to payments to philanthropic entities, adding R$ 634.87 million to the Medium and High Complexity financial ceiling of the states, the Federal District and municipalities, to be transferred by the National Health Fund in a single installment.

• Ordinance GM/MS No. 6,465 updated the SUS Table amounts for specialized care procedures, adding R$ 700.56 million to the group. Together, the two measures injected more than R$ 1.3 billion into SUS funding for medium and high complexity.

One point of concern became clear in the following months: representatives of the philanthropic sector reported in April 2025 that part of the funds had not yet actually reached the institutions. The publication of the ordinances and the arrival of funds in hospitals’ cash accounts are distinct steps, and monitoring payments remains a critical responsibility for managers.

What is still open

The progress of 2024 and early 2025 is important, but it does not solve the problem once and for all. Law No. 14,820/2024 prevents the lag from growing, but it does not restore the liability accumulated over more than a decade.

Three points remain without a structural solution: the absence of a minimum correction rate, which leaves the annual adjustment subject to budget availability; the delay between the publication of ordinances and the actual arrival of funds at the institutions; and the volume of debt accumulated by the philanthropic sector, which compromises investment capacity regardless of recent adjustments.

For the sector, the legislative progress is a starting point. The long-term sustainability of these institutions depends on a more predictable financing policy, with clear correction rules and fast mechanisms for transferring approved funds.

The SUS lag and the health plan revenue cycle

For hospitals that serve both SUS and health plan payers, the public table lag makes billing efficiency with private health plans even more critical. When SUS payments do not cover operating costs, avoidable denials, underbilling and payment delays start to threaten the institution’s financial balance.

Many institutions already use artificial intelligence to optimize the revenue cycle and reduce denials. AI makes it possible to read and interpret clinical texts, detect documentation gaps before submission, cross-check data against each payer’s rules and generate denial appeals automatically.

Rivio uses artificial intelligence to manage the entire hospital revenue cycle, from audit to payment, allowing hospitals and clinics to focus on what really matters: caring for the health of the Brazilian population.

Frequently asked questions about the SUS Table update

1. When is the SUS Table updated?

Under Law No. 14,820/2024, the revision became mandatory every December. The rate is set by the Ministry of Health according to budget availability. Before this law, there was no mandatory frequency: the last broad revision had taken place in 2013.

2. What changed for philanthropic hospitals with the December 2024 ordinances?

Ordinances GM/MS No. 6,464 and No. 6,465 put the law’s first adjustment into effect, adding more than R$ 1.3 billion to SUS funding for medium and high complexity. No. 6,464 applied the 3.5% adjustment to payments to philanthropic entities; No. 6,465 updated the SUS Table amounts for specialized care procedures.

3. What is the Tabela SUS Paulista and how does it work?

It is a São Paulo state government program that uses state funds to supplement the amounts paid by the Ministry of Health, reaching up to five times the national table amount. In 2025, it benefits 786 institutions and adjusted 158 procedures, with an impact of more than R$ 134 million.

4. What are Integrated Care Offerings (OCI)?

They are the new PMAE payment model: instead of paying for individual procedures, the government pays for care packages that ensure the patient completes treatment within 30 to 60 days. The priority specialties are oncology, cardiology, orthopedics, otolaryngology and ophthalmology.

5. Does Law No. 14,820/2024 solve the SUS Table’s historical lag?

Not entirely. The law creates an annual revision mechanism that prevents the lag from growing, but it does not restore the liability accumulated since 2013. Without a minimum correction rate, the adjustment remains subject to budget availability, with no guarantee of real correction over time.