(Nov. 26, 2025) – 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 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.
- 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 percent when a hospital agrees with CMS' determination of their noncompliance and waives the right to a hearing.
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