Medicare Payment Glitches Fixed: Hospitals Breathe Easier
Published Date: 2/23/2026
Rule
Summary
This document fixes some technical mistakes in the Medicare rules for hospital outpatient and surgery center payments that started January 1, 2026. Hospitals, surgery centers, and patients can expect clearer payment systems, updated quality ratings, and better price transparency. These corrections make sure everything runs smoothly without changing the original payment or reporting deadlines.
Analyzed Economic Effects
6 provisions identified: 4 benefits, 1 costs, 1 mixed.
OPPS Conversion Factor Number Corrections
CMS corrected two figures used in the CY 2026 OPPS conversion factor calculation: the factor line changed from 0.9955 to 0.9995, and the dollar figure changed from $91.456 to $90.317. These corrections apply to the calculation text for CY 2026 payments.
Inpatient-Only List Elimination Date Corrected
CMS corrected the final date for elimination of the Inpatient-Only (IPO) list from January 1, 2028 to January 1, 2029. The corrected date applies to the timeline referenced in the CY 2026 rule.
Technical Corrections Keep Medicare Rules Stable
CMS fixed technical errors in the CY 2026 hospital outpatient and ambulatory surgical center rules so the payment, reporting, and quality policies read correctly. These corrections are intended to make systems clearer and run smoothly without changing the underlying payment methods or reporting deadlines.
Two C-APCs Added (72 → 74)
CMS clarifies that two Clinical Ambulatory Payment Classifications (C-APCs) — APC 5433 (Level 3 Nerve Procedures) and APC 5117 (Level 7 Musculoskeletal Procedures) — are being added for CY 2026, increasing the C-APC count from 72 to 74. This clarifies the final CY 2026 C-APC list.
Coding and Descriptor Text Corrections
CMS corrected HCPCS/CPT long descriptors and APC assignments for several codes (including CPT 0786T, HCPCS codes 20802 and 20805 descriptors, and HCPCS C9810 wording) to the exact text shown in the correcting document. These corrections ensure the official code descriptions match CMS intent for CY 2026.
Quality Reporting and Price Transparency Fixes
CMS fixed omissions and URL/text errors in quality reporting program materials (OQR, REHQR, ASCQR), added omitted language for the Hospital Commitment to Health Equity removal and an eCQM numerator description, and corrected Medicare Care Compare links so public price and quality information points to the correct pages.
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