Federal Advocate Articles
CMS Issues OPPS Final Rule and Expands Site-Neutral Payments and Hospital Price Transparency

Rules Regulations Compliance (Dec. 3, 2025) - 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 on Nov. 21.

Major updates include the following:

OPPS

  • Increases the OPPS payment rates by 2.6 percent, which is a 0.2 percent increase from the proposed rule; this is based on a 3.3 percent market basket update, less a 0.7 percent productivity adjustment.
  • Reduces off-campus provider-based department payments for drug administration services. These site neutral payment rates will reduce OPPS payment for these services by approximately 60 percent beginning in 2026 in all off-campus provider-based departments except rural Sole Community Hospitals.
  • 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. Instead, CMS finalized that in 2026 CMS will institute a 0.5 percent payment reduction. CMS made clear that hospitals should plan for greater reductions, up to 2 percent, in 2027 and beyond. 
  • 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. Hospitals will now be required to make public the actual dollar amounts in its MRF and submit formal attestation stating the MRF is accurate, complete and approved by the hospital CEO or designated senior official.
  • Finalizes the reduction of civil monetary penalties by 35 percent when a hospital agrees with CMS’ determination of their noncompliance and waives the right to a hearing.
  • Announced a drug acquisition cost survey that CMS will conduct between Jan. 1 through March 31, 2026. CMS is expected to use the results of this survey to reduce Medicare payments to hospitals.

ASC

  • Increases ASC rates by 2.6 percent, which is based on the IPPS market basket percent increase of 3.3 percent, less the 0.7 percent 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 percent.
  • Decreases the outlier fixed dollar loss threshold from $234.26 to $162.43.