Part B HOPPS Proposed Rule

CMS issued a proposed rule that would update Medicare payment policies and rates for hospital outpatient and ambulatory surgical center (ASC) services under the Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Proposed Rule for CY 2027. CMS is publishing this proposed rule consistent with the legal requirements to update Medicare payment policies for hospital outpatient and ASCs annually.

The proposed rule also includes:

• Updates to OPPS and ASC payment rates
• Expanding the method to control unnecessary increases in the volume of outpatient services
• Reduced payments for 340B-acquired drugs based on the Medicare OPPS Drugs Acquisition Cost Survey
• Eliminating the inpatient only list
• Request for Information on strengthening the standardization and comparability of hospital price transparency data – rider
• Hospital Outpatient Quality Reporting Program
• ASC Quality Reporting Program
• Prior authorization for additional botulinum toxin injection codes

More Information: 

• Full fact sheet 
• CMS Acts to Strengthen Care Quality, Cut Drug Costs & Slash Out-of-Pocket Expenses for Medicare Beneficiaries press release
• Hospital OPPS webpage

For more information about Hospital Outpatient Prospective Payment System (OPPS), visit: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient

CMS WILL ACCEPT PUBLIC COMMENTS ON THE PROPOSED RULE FOR 60 DAYS FOLLOWING ITS PUBLICATION IN THE FEDERAL REGISTER. To view the proposed rule, visit: https://www.federalregister.gov/d/2026-13656 

Updates on Fee Schedules Part B

 ASC Fee Schedules Effective July 1, 2026

Updated 2026 Ambulatory Surgical Center (ASC) Fee Schedules

Updated 2026 Specialty Pricing