CMS Establishes Final Rule to Enhance Pricing Transparency

CMS has established a final rule for 2026 that “advances a series of patient-focused reforms that will modernize payments, expand access to care, enhance hospital accountability, and safeguard the Medicare Trust Funds from fraud, waste, and abuse.”

The rule, titled the “2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule,” is meant to “control unnecessary increases in the volume of covered outpatient department services to align payments for certain services delivered in hospitals and off-campus facilities. In addition to encouraging appropriate care delivery, this policy will help ensure beneficiaries aren’t penalized with additional copays simply based on where they receive care. The rule also finalizes phasing out the inpatient-only list and expanding the ambulatory surgical center covered procedures list, which will give physicians greater flexibility to determine the most clinically appropriate setting for care and allow more patients to choose outpatient surgical options while maintaining patient safety.”

HHS secretary Robert F. Kennedy, Jr. says that the rule “closes the loopholes hospitals exploit to hide real prices and advances President Trump’s demand for radical hospital price transparency.”

CMS is also “improving hospital price transparency rules. The finalized changes require hospitals to post real, consumer-usable prices, not estimates, and provide data in standardized formats so patients can understand what their care will actually cost. Hospitals that fail to comply will face civil monetary penalties.”