# 2025-20907: Medicare Reshuffles Hospital Money While Teaching Hospital Goes Belly-Up 2025-20907, Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Rating; Hospital Price Transparency; and Notice of Closure of a Teaching Hospital and Opportunity To Apply for Available Slots, is a Federal Register rule from Health and Human Services Department, Centers for Medicare & Medicaid Services published 2025-11-25, effective 2026-01-01; deemed significant under Executive Order 12866; PRIA reads it as touching household money (as of 2026-06-11). - Canonical: https://policyrisk.com/federal-register/2025-20907 - As of: 2026-06-11 - Plain-text twin of the page above; the HTML and this file carry the same facts. ## Facts - Document number: 2025-20907 - Title: Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Rating; Hospital Price Transparency; and Notice of Closure of a Teaching Hospital and Opportunity To Apply for Available Slots - Type: Rule - Agencies: Health and Human Services Department; Centers for Medicare & Medicaid Services - Citation: 90 FR 53448 - Published: 2025-11-25 - Effective: 2026-01-01 - Comments close: not stated - Significant: yes (FR_METADATA) - Touches household money: yes - Regulation identifier numbers: 0938-AV51 - Last updated: 2026-06-11 ## In one line Medicare Reshuffles Hospital Money While Teaching Hospital Goes Belly-Up ## Summary Starting in 2026, Medicare is updating how it pays hospitals and surgery centers for outpatient care, making sure payments are fair and clear. Hospitals must keep sharing quality scores and prices so patients can shop smart, while a teaching hospital is closing and offering its spots to others. These changes affect hospitals, surgery centers, and patients, with new rules kicking in next year and some money adjustments to watch for. ## Abstract This final rule with comment period revises the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2026 based on our continuing experience with these systems. We also describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment systems. In addition, this final rule with comment period announces the closure of a teaching hospital and the opportunity to apply for available slots, and updates and refines the requirements for the Hospital Outpatient Quality Reporting Program, Rural Emergency Hospital Quality Reporting Program, Ambulatory Surgical Center Quality Reporting Program, Overall Hospital Quality Star Rating, and hospitals to make public their standard charge information and enforcement of hospital price transparency, as well as summarizes comments received in response to a request for information on measure concepts regarding Well-Being and Nutrition for consideration in future years for the OQR, REHQR, and ASCQR programs. ## Effects PRIA read - OPPS Payment Rates Up 2.6% in 2026: mixed, high. Starting January 1, 2026, Medicare is increasing Hospital Outpatient Prospective Payment System (OPPS) payment rates by an OPD fee schedule increase factor of 2.6 percent. CMS estimates total OPPS payments (including beneficiary cost sharing) for CY 2026 will be about $101.0 billion—roughly $8.0 bi… - ASC Payment Update: 2.6% Increase: mixed, medium. For calendar year 2026, Medicare is increasing payment rates under the Ambulatory Surgical Center (ASC) payment system by 2.6 percent for ASCs that meet quality reporting requirements. CMS estimates total Medicare payments to ASCs for CY 2026 will be about $9.2 billion, an increase of roughly $450… - Many More Procedures Allowed at ASCs: benefit, medium. Effective for CY 2026, CMS is expanding the ASC Covered Procedures List by adding 276 procedures under revised criteria and by adding 271 additional codes moved from the Inpatient-Only list. This change lets more procedures be performed in ASCs instead of inpatient hospital settings. - Phase-Out of Inpatient-Only (IPO) List Starts: benefit, medium. CMS is phasing out the Inpatient-Only (IPO) list over three years beginning in CY 2026 by removing 285 mostly musculoskeletal services for CY 2026. Those services may be furnished and paid in outpatient settings going forward. - Tc-99m Domestic Add-On Payment: $10 Per Dose: benefit, low. For CY 2026, CMS finalizes a $10 per dose add-on payment for radiopharmaceutical doses of technetium-99m (Tc-99m) produced from domestically produced molybdenum-99 (Mo-99). To qualify, at least 50 percent of the Mo-99 in the Tc-99m generator used for the dose must be domestically produced; CMS esta… - Hospital Price Transparency Data Changes: benefit, low. Beginning January 1, 2026 (with enforcement delayed until April 1, 2026), hospitals must report new machine-readable file elements when payer-specific negotiated charges are based on percentages or algorithms: the 10th percentile allowed amount, the median allowed amount (replacing the estimated al… - Enforcement Change: CMP Reduction Option: benefit, low. Starting January 1, 2026, CMS will reduce a civil money penalty (CMP) by 35 percent in certain cases when a hospital admits it violated hospital price transparency requirements and waives its right to an ALJ hearing, to encourage faster settlement and payment of CMPs. - Hospital Quality Star Rating Emphasis on Safety: benefit, low. CMS is changing the Overall Hospital Quality Star Rating methodology to emphasize Safety of Care. For the 2026 rating, hospitals in the lowest quartile of Safety of Care (with at least three Safety of Care measures) will be limited to a maximum of four stars; starting with the 2027 rating, hospital… - Market-Based MS-DRG Data Reporting Starts 2026: mixed, medium. For cost reporting periods ending on or after January 1, 2026, hospitals must report the median of payer-specific negotiated charges by MS-DRG (from their most recent machine-readable file) on the Medicare cost report. CMS will use that market-based information to change the IPPS MS-DRG relative we… - 340B Remedy Offset and OPPS Conversion Factor Cut: cost, medium. CMS is applying a previously finalized 0.5 percentage point reduction to the OPPS conversion factor for non-drug items and services for hospitals to which the 340B remedy offset applies, and estimates the 340B remedy offset will reduce payments by $275 million in CY 2026 for affected hospitals. ## Related documents - [2026-22812](https://policyrisk.com/federal-register/2026-22812): Medicare and Medicaid Programs; Cutting Administrative Requirements for Excellence in Patient Care, 2026-11-10 - [2026-22750](https://policyrisk.com/federal-register/2026-22750): Calendar Year 2027 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the E…, 2026-11-09 - [2026-22792](https://policyrisk.com/federal-register/2026-22792): Medicare Drug Price Negotiation Program and Medicare Prescription Drug Benefit Program, 2026-11-09 - [2026-22743](https://policyrisk.com/federal-register/2026-22743): Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage…, 2026-11-09 - [2026-22739](https://policyrisk.com/federal-register/2026-22739): Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; and Quality Reporting Programs; i…, 2026-11-06 - [2026-22381](https://policyrisk.com/federal-register/2026-22381): Medicare and Medicaid Programs; Organ Procurement Organizations Conditions for Coverage: Revisions to the Conditions for Coverage, 2026-11-03 ## Sources - [2025-20907 on federalregister.gov](https://www.federalregister.gov/documents/2025/11/25/2025-20907/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment) - [2025-20907 as published (PDF)](https://www.govinfo.gov/content/pkg/FR-2025-11-25/pdf/2025-20907.pdf) ## Related - [Previous: 2025-20835, Scope of Federal Regulations Implementing the Surface Mining Control and Reclam…](https://policyrisk.com/federal-register/2025-20835) - [Next: 2025-20910, Airworthiness Directives; Airbus SAS Airplanes](https://policyrisk.com/federal-register/2025-20910) - [All Federal Register documents](https://policyrisk.com/federal-register) Source: PRIA, https://policyrisk.com/federal-register/2025-20907 (as of 2026-06-11).