On November 21, 2025, CMS put on display the Calendar Year 2026 Outpatient Prospective Payment System Final Rule (CMS-1834-FC).
Here is a link to the Fact Sheet from CMS that summarizes the displayed Rule.
Here is a link to the Forthcoming Rule on display.
- OPPS payments up 2.6% (3.3% market basket – 70 basis point productivity adjustment) for hospitals that meet quality reporting requirements
- ASC rates also increased 2.6% using the hospital market basket update for ASCs meeting applicable quality reporting requirements
- Expanded volume control measures for PBD’s by making drug administered services subject to the Physician Fee Schedule equivalent payment rate at a PBD not included in section 603 of the Bipartisan Budget Act of 2015
- Eliminates Inpatient Only List over 3 years starting with 285 procedures in CY 2026
- CMS added 289 procedures to the ASC CPL along with 271 codes removed from the IPO list
- 340B Underpayment Remedy claw back, annual offset percentage for non-drug items and services codified at .5% rather than proposed 2%; increase in claw back % anticipated CY 2027 and thereafter
- Finalized notice of intent to conduct acquisition cost surveys for each specified covered outpatient drug; this is groundwork to reinstate lower payments for separately drugs to 340B hospitals
Here is a link to the Fact Sheet from CMS that summarizes the displayed Rule.
Here is a link to the Forthcoming Rule on display.
