CMS Releases Proposed Medicare Hospital Outpatient Payment Rates and Policies for 2027

The Centers for Medicare and Medicaid Services (CMS) published a proposed rule on Tuesday that would increase Medicare payment rates by 2.4% for hospital outpatient services and ambulatory surgical centers (ASCs) that meet quality reporting requirements for calendar year 2027. CMS calculated that the proposed update, combined with other proposed payment policies, would result in an overall increase of 1.9%, or $1.8 billion in payments over the 2026 calendar year.

CMS released an accompanying fact sheet that outlines key provisions in the proposed rule. Examples of proposed policy changes that would impact hospitals include lowering payments for certain imaging services done at off-campus hospital clinics to the payment rates received for the services when furnished in a doctor’s office; significantly reducing payments to hospitals for drugs acquired through the 340B program; expediting the applicability of a payment reduction for non-drug items and services; updating validation and validation appeals procedures for digital quality measures; and removing 638 more services from the "inpatient only" list, which will allow for the services to be paid by Medicare in the hospital outpatient setting when clinically appropriate.

Additionally, CMS’ proposed rule includes updates to the payment rates for blood, transfusion services, and biotherapies furnished in the hospital outpatient setting. AABB is preparing a summary of the proposed payment policies and rates most relevant to the transfusion medicine and biotherapies community.

The agency is accepting comments on the proposed rule through Aug. 31 and will release a final rule in early November.