Promoting Fairness for Medicare Providers Act of 2026

New Medicare rules for high-cost surgeries

This bill would change how Medicare pays for certain high-supply-cost surgical procedures starting in 2027. A procedure would qualify based on a 2023 baseline and a supply-item price test, and the agency would review and update the list each year beginning in 2028 using a threshold tied to the Medicare Economic Index. The bill would let a physician's office enroll as an "office-based facility" if it meets health and safety standards and agrees to accept the bill's payment amount and assignment rules for those procedures. For covered procedures, Medicare would pay office-based facilities like ambulatory surgical centers but generally at reduced rates (for example, facility pay set at 90 percent of the ASC amount and other 1834(bb) adjustments), and an individual's annual coinsurance for these facility services would be capped at that year's inpatient hospital deductible; if the uncapped coinsurance would exceed the deductible, the agency would increase the facility payment so the facility's total payment is preserved.