CMS has issued a final OPPS rule for 2026, confirming a net 2.6% payment update, plans to expand site-neutral payment policies, and new pricing transparency requirements.
CMS has issued the 2026 Hospital Outpatient Prospective Payment System (OPPS) Final Rule, setting a net payment rate increase of 2.6% for hospitals and ambulatory surgical centers (ASCs) that meet quality reporting requirements. This rate includes a 3.3% market basket update offset by a 0.7 percentage point productivity cut.
The 0.5% downward offset to payments recoupment for 2026 may increase to up to 2% in 2027, driven by a burdensome new drug cost survey.
The American Hospital Association (AHA) immediately expressed disappointment, calling the payment update "inadequate" and criticizing the agency for "exacerbating the challenging financial pressures" facing providers.
The final rule confirms several major policy changes with significant implications for hospital revenue cycles.
Expansion of Site-Neutral Payments and IPO List Phase-Out
CMS confirmed its intention to expand site-neutral payment policies, solidifying cuts that remove distinctions between hospital outpatient departments and other sites of care.
- Site-Neutral Policy: CMS finalized its proposal to pay for drug administration services furnished in grandfathered off-campus hospital outpatient departments at the site-neutral rate of 40% of the OPPS rate. This policy is estimated to cut OPPS spending by $290 million in CY 2026.
- Inpatient Only (IPO) List: CMS also finalized the phase-out of the IPO list over a three-year period.
The AHA strongly opposes these policies, arguing they "ignore the important differences between hospital outpatient departments and other sites of care" and fail to account for the fact that hospital outpatient departments serve patients who are "sicker, more clinically complex, and more often disabled or residing in rural or low-income areas.”
An Offset to Recoup Overpayments
CMS also finalized a policy to recoup $7.8 billion in overpayments for non-drug services that were made as part of a change, later determined to be illegal, to the 340B Drug Payment Program.
For now, the agency will move forward with a 0.5% reduction in the OPPS conversion factor starting January 1, 2026. However, the agency explicitly stated this reduction is only for 2026 and warned hospitals to plan for greater reductions, potentially up to 2%, in 2027 and beyond.
“An accelerated timeline, either now or in the future, is both bad policy and unlawful,” the AHA responded.
Compounding this long-term risk, CMS finalized a new drug acquisition cost survey beginning in late CY 2025 or early 2026.
New Price Transparency Requirements
The final rule moves forward with new requirements for pricing transparency, but pushes the deadline for compliance to April 1, 2026.
New rules require hospitals to post actual allowed amounts rather than estimates and create new data standards for the calculation of allowed amounts. Noncompliant facilities will face civil monetary penalties if they fail to disclose shoppable services.
Luke Gale is the revenue cycle editor for HealthLeaders.
KEY TAKEAWAYS
The net OPPS payment update is 2.6%, but CMS finalized the expansion of site-neutral payments.
CMS abandoned plans to accelerate recovery of overpayments associated with the 340B program, but warned those plans could be revived.
CMS confirmed requirements for hospitals to post pricing for actual allowed amounts rather than estimates.