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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:
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2.4% payment increase for ASCs and hospital outpatient departments for those meeting quality reporting requirements.
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Adding more than 500 procedures that can be performed in ASCs, including GI code POEM (CPT 43497). 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.
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Cuts to drug administration payments to excepted off-campus provider-based departments. 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.
The GI societies are continuing our in-depth review of the proposed policies to gauge the impact on GI. We will provide additional analysis about the rules – including MPFS, HOPD, and ASC – with updates on how the proposed rules will impact you and how to get involved.
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