- within Food, Drugs, Healthcare and Life Sciences topic(s)
- in United States
- with readers working within the Banking & Credit, Healthcare and Pharmaceuticals & BioTech industries
- within Compliance topic(s)
On Nov. 21, the Centers for Medicare and Medicaid Services (CMS) released the 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Final Rule (Final Rule). The Final Rule outlines changes to Medicare payments for hospital and surgery center outpatient services effective Jan. 1, 2026. Among other changes, the Final Rule details significant reimbursement updates, including:1
- OPPS/ASC Reimbursement Increase: CMS finalized an increase to OPPS and ASC payment rates of 2.6%, which includes a 3.3% increase for the hospital market basket percentage reduced by a 0.7% productivity adjustment.
- Inpatient Only List Phase Out: CMS will begin the phase out of the inpatient only (IPO) list over the next three years, including 285 musculoskeletal procedures being removed in 2026. This change will allow more procedures to be performed in outpatient settings, potentially increasing ASC volumes and complexity.
- ASC Covered Procedure List: The Final Rule adds 289 procedures to the ASC Covered Procedure List (CPL) in 2026. Additionally, CMS added 271 codes to the ASC CPL, which will be removed from the IPO list in 2026.
- ASC Market Basket Update: The hospital market basket update was initially planned to be applied in determining ASC payment rates through 2023. This was initially extended through 2025, and CMS finalized an extension for the utilization of the hospital market basket update in the ASC payment system through 2026.
The Final Rule ultimately included a slightly higher reimbursement increase for ASCs than originally proposed and demonstrates CMS's continued effort to move procedures to the lowest cost site-of-service. Many large health systems have made strategic investments in outpatient care over the past few years, and Ankura expects this interest in ASCs will continue as operators look to preserve and grow revenues.
Footnote
1. Calendar Year 2026 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule Fact Sheet
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
