The Centers for Medicare & Medicaid Services (CMS) has announced updates to the Medicare payment policies and rates for hospital outpatient and Ambulatory Surgical Center (ASC) services under the Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Final Rule for 2026. This update affects approximately 4,000 hospitals and 6,000 ASCs.
A key change includes a 2.6% increase in OPPS payment rates for hospitals meeting quality reporting requirements. This adjustment is based on a market basket percentage increase of 3.3%, reduced by a productivity adjustment of 0.7 percentage points. The same update applies to ASC rates.
The final rule also expands a policy from 2019 to control unnecessary increases in outpatient service volumes, now including drug administration services in off-campus provider-based departments (PBDs). CMS estimates this will reduce OPPS spending by $290 million, saving Medicare $220 million and beneficiaries $70 million through reduced coinsurance.
CMS plans to phase out the Inpatient Only (IPO) list over three years, starting with removing 285 musculoskeletal procedures in 2026. This aims to offer beneficiaries more care options with potentially lower out-of-pocket costs.
For skin substitutes used in outpatient settings, CMS will unpackage these products from application services and categorize them based on product characteristics aligned with FDA regulatory status. This change seeks to encourage competition and innovation while saving the Medicare Trust Fund money.
The rule also maintains temporary additional payments for certain non-opioid pain relief treatments from January 1, 2025, through December 31, 2027. CMS has finalized five drugs and eleven devices qualifying as non-opioid treatments for separate payments starting in CY 2026.
CMS will continue incentivizing domestic production of Molybdenum-99 by establishing an add-on payment of $10 per dose of Technetium-99m derived from domestically produced Mo-99 beginning January 1, 2026.
Lastly, CMS has made modifications to hospital price transparency regulations requiring hospitals to provide clear pricing information starting January 1, 2026. Enforcement of these requirements will begin April 1, 2026.
For more details on these updates or to view the final rule document, visit: https://www.federalregister.gov/documents/current
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