CMS 2026 Medicare OPPS and ASC Final Rule Advances Site-Neutral Payments and Expands Price Transparency

In its final rule for calendar year 2026, the Centers for Medicare & Medicaid Services (CMS) is implementing significant changes to Medicare payment policies affecting hospital outpatient departments (OPPS) and ambulatory surgery centers (ASCs). These changes largely follow prior proposed adjustments aimed at enhancing cost efficiency and expanding service access. Key modifications include the phased removal of the Inpatient Only list over three years, beginning with 285 musculoskeletal-related procedures in 2026, allowing these to be performed in outpatient and ASC settings. The ASC Covered Procedures List will also expand with the addition of 560 procedures to accommodate this shift. CMS is broadening site-neutral payment policies to drugs administered in off-campus hospital departments, reducing reimbursements to about 40% of OPPS rates, which will significantly impact hospital-based cancer and infusion centers, although rural Sole Community Hospitals will be exempted to ensure access. Hospital price transparency requirements are being updated to improve data accuracy and accountability, including mandatory senior executive attestation on the integrity of machine-readable files and allowances for penalty reductions upon voluntary noncompliance admissions. Enforcement of new transparency requirements is delayed until April 1, 2026, to facilitate operational adjustments. The rule also permanently permits direct clinician supervision of certain rehabilitation and diagnostic services via real-time audio-video communication, expanding telehealth capabilities. CMS finalized payment rates for a range of software-as-a-service products related to diagnostic imaging but refrained from committing to standardized payment models for such technologies. The rule introduces anti-discrimination criteria within medical residency program accreditation processes and signals consideration of nutrition education standards in graduate medical education. CMS will conduct a nationwide survey of hospital acquisition costs for outpatient drugs, excluding radiopharmaceuticals, to inform future OPPS payment policies, with hospitals required to report data for drugs paid under OPPS between July 1, 2024, and June 30, 2025. The agency postponed a proposed increase in payment reductions related to the 340B drug program but anticipates further adjustments in 2027. A payment update increases OPPS and ASC rates by 2.6%, with corresponding penalties for quality reporting failures. Collectively, these changes will raise Medicare OPPS and ASC expenditures by approximately $8 billion and $450 million, respectively. This comprehensive final rule reflects CMS's ongoing efforts to align payment structures with evolving care delivery models, reinforce transparency and compliance, and improve resource allocation in Medicare's outpatient services arena.