CMS Releases CY 2026 Final Medicare OPPS, ASC And ESRD Payment And Policy Updates

The Centers for Medicare & Medicaid Services released the calendar year 2026 Medicare hospital Outpatient Prospective Payment System, updates to the Ambulatory Surgical Center payment program and the End-stage Renal Disease Prospective Payment System. Major updates include the following.

OPPS

• increases the OPPS payment rates by 2.6%, which is a 0.2% increase from the proposed rule; this is based on a 3.3% market basket update, less a 0.7% productivity adjustment
• reduces off-campus provider-based department payments for drug administration services
• phases out the inpatient-only list over a three-year period beginning with the elimination of 285 procedures
• did not finalize the accelerated repayment of the 340B remedy
• further revises hospital price transparency rules by requiring hospitals to disclose the 10th, median and 90th percentile amounts to be reported within the machine-readable files
• finalizes the reduction of civil monetary penalties by 35% when a hospital agrees with CMS’ determination of their noncompliance and waives the right to a hearing

ASC

• increases ASC rates by 2.6%, which is based on the IPPS market basket percent increase of 3.3%, less the 0.7% productivity adjustment
• extends the use of hospital market basket update as the update factor used for the ASC payment system by one additional year

ESRD

• CMS is estimating ESRD PPS payments to increase by 2.2%
• decreases the outlier fixed dollar loss threshold from $234.26 to $162.43

 MHA published an issue brief with additional information.