CMS Finalizes 2026 Medicare OPPS and ASC Payment Rates with 2.6% Increase

The Centers for Medicare & Medicaid Services (CMS) released the final rule for the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for calendar year 2026.

The rule includes updated payment rates and regulations affecting Medicare services in hospital outpatient and ambulatory surgical center settings. For 2026, CMS increased payment rates under the OPPS and ASC systems by 2.6%, reflecting a hospital market basket increase of 3.3% minus a productivity adjustment of 0.7 percentage points. Hospitals and ASCs not meeting quality reporting requirements will face a 2.0 percentage point payment reduction, consistent with existing policy. CMS maintained the 0.5% payment reduction related to the 340B drug discount program instead of implementing proposed changes.

The final rule project payments to OPPS and ASC providers to reach approximately $101.0 billion and $9.2 billion respectively for 2026, marking increases of roughly $8.0 billion and $450 million over 2025 levels. This reflects growth in beneficiary cost-sharing, enrollment, utilization, and case-mix factors. Stakeholders have until January 20, 2026, to submit comments on the rule.

Additionally, McDermott+ introduced an interactive dashboard displaying finalized Medicare fee-for-service (FFS) payment rates for 2026 across OPPS, ASC, and Physician Fee Schedule (PFS) systems. The tool offers detailed information by procedure code, including CMS-calculated geometric mean costs and device offsets. The dashboard aims to support providers, device manufacturers, and others in tracking Medicare payment rate changes and facilitating strategic planning.

This comprehensive update underscores CMS's ongoing efforts to balance cost adjustments with quality incentives in outpatient care reimbursement. Providers and industry participants should review the finalized payment rates and quality reporting compliance requirements to understand their financial and operational impact for 2026. The availability of granular payment data through the McDermott+ dashboard highlights increasing transparency and data-driven decision-making support in the Medicare payment landscape.