Federal Register #2026-13656

CMS Proposed Updates to Medicare Outpatient and Ambulatory Surgical Center Payment Systems for Advanced Medical Procedures

This opportunity involves the Centers for Medicare & Medicaid Services (CMS), part of the Department of Health and Human Services, proposing updates to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment systems for the upcoming calendar year. - Government Buyer: - Department of Health and Human Services (HHS) - Centers for Medicare & Medicaid Services (CMS) - Products/Services Requested: - Payment system updates for hospital outpatient and ambulatory surgical center services - Specific medical procedures and device-related services, including: - Subretinal therapies requiring vitrectomy (CPT 0810T) - BgRT modeling and treatment delivery (HCPCS G0562, G0563) - Liver and renal histotripsy services (CPT 0686T, 0888T) - LimFlow TADV procedure (HCPCS 0620T) - SAINT Neuromodulation System services (CPT 0889T, 0890T, 0891T, 0892T) - Skin cell suspension autograft procedures (CPT 15X19–15X22) - Integrated sacral neurostimulator (CPT 0786T) - Permanent prostatic urethral stent (CPT 52282) - Electrophysiologic evaluation of cardiac contractility modulation systems (CPT 0930T) - Endovenous femoral-popliteal arterial revascularization with stent graft (CPT 0505T) - Notable Requirements: - 2.4% payment rate increase proposed - Expansion of prior authorization to additional Botulinum Toxin Injection services - New device pass-through payments for innovative medical devices - Payment adjustments for 340B-acquired drugs - Exemptions for certain hospital types from specific payment adjustments - Focus on quality reporting, wage index updates, and outlier payments - OEMs and Vendors: - No specific OEMs or vendors are named in the documentation, but the procedures and devices referenced suggest involvement of manufacturers specializing in neuromodulation, histotripsy, vascular stents, and advanced surgical devices.

Description

This proposed rule aims to revise the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2027. It includes updates to payment rates, quality reporting programs, and prior authorization requirements, specifically expanding prior authorization to additional Botulinum Toxin Injection services. The rule also addresses implementation of provisions from the Consolidated Appropriations Act, 2026, notices of closure of teaching hospitals, and requests information on improving the standardization and comparability of hospital price transparency data. Additionally, it proposes accrediting organizations to assess compliance with EMTALA requirements during surveys and solicits comments on potential separate payments under the Inpatient Prospective Payment System for domestic procurement of personal protective equipment and essential medicines.

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