On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule [CMS-1834-P], which includes proposals to update payment rates and regulations affecting Medicare services furnished in hospital outpatient and ambulatory surgical center (ASC) settings beginning in CY 2026.
CMS proposes to increase payment rates under the Hospital Outpatient Prospective Payment System (OPPS) and the ASC Payment System by 2.4%. CMS continues to implement the statutory 2 percentage point reduction in payments for hospitals that fail to meet the hospital outpatient quality reporting requirements by applying a reporting factor of 0.9805 to the OPPS payments and copayments for all applicable services. CMS notes that payments for services at hospitals subject to the proposed 340B remedy offset will be reduced by 2 percentage points.
Based on the proposed policies, CMS estimates that total payments to OPPS and ASC providers (including beneficiary cost-sharing and estimated changes in enrollment, utilization, and case-mix) for CY 2026 will be about $100 billion and $9.2 billion, respectively. This represents an increase of about $8.1 billion and $480 million, respectively, from CY 2025 payment levels.
Comments on the proposed rule are due September 13, 2025.
The full summary of the proposed rule is for McDermott+ clients only; please contact your relationship consultant with questions. For inquiries, please contact info@mcdermottplus.com.
McDermott+’s new, interactive dashboard for PFS, Outpatient Prospective Payment System (OPPS), and Ambulatory Surgical Care (ASC) shows key information published by CMS for individual procedure codes. This includes for individual procedure codes (where applicable), the payment rate through the Medicare physician fee schedule, outpatient prospective payment system, and ambulatory surgical center payment system, plus status and payment indicators, geometric mean costs, device offset amounts, and other useful information.
This dashboard can be used by providers, device manufacturers and the general public to see how payments for services of interest have changed across years and see how much their services are getting paid across localities.
