On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released the CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule, outlining updates to Medicare payment policies and rates for hospital outpatient and ASC services.
Here are the top takeaways:
CMS also proposes relaxing criteria for adding procedures to the ASC Covered Procedures List (ASC CPL), which could open the door for the inclusion of more GI procedures and tests.
This would expand a method first implemented to control volume and remove the site-of-service differential for drug administration at clinic visits by reducing payments to the Physician Fee Schedule equivalent rate. This will impact GI drugs administered via infusion.