CMS Releases CY 2027 Proposed Medicare OPPS And ASC Payment And Policy Updates

The Centers for Medicare & Medicaid Services released the Medicare hospital Outpatient Prospective Payment System and Ambulatory Surgical Center payment and policy updates for calendar year 2027. Major updates include the following.

OPPS

• Increases the OPPS payment rates by 2.4%, based on a 3.2% market basket update, less a 0.8% productivity adjustment
• Reduces off-campus provider-based department payments for imaging without contrast services. CMS estimates this will “reduce Medicare Part B expenditures by approximately $260 million in the first year, including approximately $190 million in Part B savings and $70 million in reduced beneficiary premiums.”
• Updates payment rates for drugs purchased under the 340B Drug Pricing Program to better reflect what hospitals pay for such drugs. “This proposal would save Original Medicare a collective estimated $4.55 billion in drug expenditures, for total reduced drugs spending of approximately $5.7 billion in 2027 alone.”
• Continues phasing out the inpatient-only list over a three-year period beginning with the elimination of 638 procedures
• Issues request for information about strengthening hospital price transparency rules
• Updates the Medicare payment rates for Intensive Outpatient Program services and Partial Hospitalization Program services
• Revises the Hospital Outpatient Quality Reporting Program
• Proposes requiring prior authorization for eight additional botulinum toxin injection codes

ASC

• Increases ASC rates by 2.4%, based on the IPPS market basket increase of 3.8%, less the 0.8% productivity adjustment
• Updates the ASC Quality Reporting Program

Comments are due by Monday, Aug. 31. The Missouri Hospital Association published an issue brief with additional information.