The Centers for Medicare & Medicaid Services' (CMS) finalized its rule for the CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment system. This comprehensive rule establishes significant payment, policy, and transparency reforms that will impact outpatient and surgical care nationwide.
Key Topics:
- A 2.4% payment rate increase for hospital outpatient departments and ASCs
- Expansion of site-neutral policies, including drug administration services
- Full phase-out of the Inpatient Only (IPO) list by 2029
- Revisions to the ASC Covered Procedures List and quality reporting programs
- New price transparency requirements and oversight provisions
- Updates on 340B remedy repayment and market-based MS-DRG weights
- Continued support for non-opioid pain relief and New Technology APCs