United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2025_register executive 2025-07-17 article Part II Proposed Rules D09002ee1d541a8ca D09002ee1d541ad80 United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency United States Office of the Secretary originator org United States Government Agency or Subagency This proposed rule would revise 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. This proposed rule would also update and refine 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. This rule also contains requests for information on measure concepts regarding Well-Being and Nutrition for consideration in future years for all three programs (OQR, REHQR, and ASCQR; expanding the method to control for unnecessary increases in the volume of covered OPD services to on- campus clinic visits; software as a service; and adjusting payment under the OPPS for services predominately performed in the ambulatory surgical center or physician office settings. 90 FR 33476 https://www.govinfo.gov/app/details/FR-2025-07-17/2025-13360 2025-13360 fr17jy25-32 RIN 0938-AV51 4120-01-P CMS-1834-P https://www.govinfo.gov/app/details/FR-2025-07-17/2025-13360 https://www.govinfo.gov/content/pkg/FR-2025-07-17/html/2025-13360.htm https://www.govinfo.gov/content/pkg/FR-2025-07-17/pdf/2025-13360.pdf Diseases Health Facilities Health Professions Laboratories Medicare Reporting and Recordkeeping Requirements Rural Areas X-Rays Administrative Practice and Procedure Puerto Rico Hospitals Hospital Price Transparency 390 p. 33476 33865 90 FR 33476 Title 42 Part 410 42 CFR Part 410 Title 42 Part 412 42 CFR Part 412 Title 42 Part 413 42 CFR Part 413 Title 42 Part 415 42 CFR Part 415 Title 42 Part 416 42 CFR Part 416 Title 42 Part 419 42 CFR Part 419 Title 45 Part 180 45 CFR Part 180 RIN 0938-AV51 Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Ratings; and Hospital Price Transparency; Federal Register Vol. 90, Issue PRORULE 2025-13360 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Office of the Secretary 2025-09-15 CMS-1834-P 4120-01-P 2025-13360 Proposed rule.

This proposed rule would revise 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. This proposed rule would also update and refine 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. This rule also contains requests for information on measure concepts regarding Well-Being and Nutrition for consideration in future years for all three programs (OQR, REHQR, and ASCQR; expanding the method to control for unnecessary increases in the volume of covered OPD services to on- campus clinic visits; software as a service; and adjusting payment under the OPPS for services predominately performed in the ambulatory surgical center or physician office settings.

To be assured consideration, comments must be received at one of the addresses provided below, by September 15, 2025. Regulation coordination questions, contact Gina Aughenbaugh via email at OutpatientPPS@cms.hhs.gov. Diseases Health Facilities Health Professions Laboratories Medicare Reporting and Recordkeeping Requirements Rural Areas X-Rays Administrative Practice and Procedure Puerto Rico Hospitals Hospital Price Transparency Medicare and Medicaid Programs Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Ratings; and Hospital Price Transparency, Abigail.Cesnik@cms.hhs.gov Anita.Bhatia@cms.hhs.gov APCPanel@cms.hhs.gov ASCPPS@cms.hhs.gov ausha.washington@cms.hhs.gov Cory.Duke@cms.hhs.gov DAC@cms.hhs.gov DevicePTapplications@cms.hhs.gov Elise.Barringer@cms.hhs.gov Erick.Chuang@cms.hhs.gov Gil.Ngan@cms.hhs.gov Kimberly.Go@cms.hhs.gov Kristina.Rabarison@cms.hhs.gov leone.kisler@cms.hhs.gov Marina.Kushnirova@cms.hhs.gov Marsha.Hertzberg@cms.hhs.gov Melissa.Hager@cms.hhs.gov Nathan.Vercauteren@cms.hhs.gov NewTechAPCapplications@cms.hhs.gov Nicole.Marcos@cms.hhs.gov OutpatientPPS@cms.hhs.gov PHPPaymentPolicy@cms.hhs.gov PriceTransparencyHospitalCharges@cms.hhs.gov Scott.Talaga@cms.hhs.gov Susan.Janeczko@cms.hhs.gov Tonya.Gierke@cms.hhs.gov Tyson.Nakashima@cms.hhs.gov ClinicalTrials.gov http://doi.org/10.1136/bmjoq-2021-001419 http://www.regulations.gov http://www.sba.gov/content/small-business-size-standards https://ascquality.org/benchmarking/ https://aspe.hhs.gov/reports/valuing-time-us-department-health-human-services-regulatory-impact-analyses-conceptual-framework https://auanews.net/issues/articles/2023/december-extra-2023/what-is-the-true-value-of-intrarenal-pressure-monitoring-during-endourologic-procedures https://blog.turquoise.health/is-price-transparency-helping-heres-three-ways-to-tell/ https://clarifyhealth.com/insights/blog/how-hospitals-can-use-price-transparency-data-to-negotiate-better-contracts-with-payers/ https://clinicaltrials.gov/ct2/show/NCT02438306 https://clinicaltrials.gov/ct2/show/NCT03455725?term=NCT03455725&rank=1 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www.bls.gov www.bls.gov/oes/current/oes132011.htm www.doi.org/10.20982/tqmp.03.2.p043 www.fda.gov Vol. 90, no. 135 Office of the Federal Register, National Archives and Records Administration 2025-07-17 continuing daily deposited born digital 616 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2025-07-17 P0b002ee1d5410c30 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr17jy25 https://www.govinfo.gov/app/details/FR-2025-07-17 https://www.govinfo.gov/content/pkg/FR-2025-07-17/pdf/FR-2025-07-17.pdf https://www.govinfo.gov/content/pkg/FR-2025-07-17/xml/FR-2025-07-17.xml fdlp 33263 33869 DGPO 2025-07-17 2025-07-17 FR-2025-07-17 machine generated eng FR FR-2025-07-17 90 135