Overview
- Medicare outpatient and ASC rates will rise 2.6% in 2026 for providers meeting quality reporting requirements, affecting roughly 4,000 hospitals and 6,000 ASCs.
- CMS will pay off-campus hospital departments physician-office rates for drug administration starting Jan. 1, a change the agency estimates will cut OPPS spending by $290 million next year.
- To recoup $7.8 billion tied to the 340B remedy, CMS will apply a 0.5% annual offset to non-drug services beginning in 2026, with the agency signaling a potential larger reduction starting in 2027.
- Medicare will begin a three-year phase-out of the inpatient-only list, with 285 procedures—mostly musculoskeletal—eligible for outpatient coverage in 2026 when clinically appropriate.
- Hospitals must publish payer-specific median, 10th and 90th percentile allowed amounts in machine-readable files on Jan. 1, with enforcement beginning April 1, as provider groups decry compressed timelines and added burdens.