The Centers for Medicare & Medicaid Services (CMS) finalized the 2026 Outpatient Prospective Payment System (OPPS) rule with a wide range of policy updates that extend beyond core payment changes.
A December 10 Coronis Health blog post breaks down a recent CMS fact sheet that outlines several additional provisions affecting drug payments, non-opioid pain management, domestic drug production incentives and hospital price transparency requirements.
Here are four takeaways:
1. CMS to survey hospital drug acquisition costs
As required under Section 1833(t)(14)(D)(ii) of the Social Security Act, CMS will conduct a nationwide survey of hospital acquisition costs for separately payable outpatient drugs. The survey will include all hospitals paid under OPPS and is expected to be completed by early calendar year 2026.
CMS intends to use the results to inform future policymaking, beginning with the CY 2027 OPPS proposed rule. Hospitals should anticipate increased scrutiny around drug acquisition data and ensure internal tracking processes are accurate and complete.
2. Non-opioid pain treatments
CMS will continue temporary additional payments for qualifying non-opioid pain management therapies provided in hospital outpatient departments through December 31, 2027.
Beginning in 2026, five drugs and 11 devices finalized under the rule will be paid separately when used as non-opioid treatments for pain relief. The policy reflects CMS’ ongoing effort to support alternatives to opioids in outpatient care settings.
3. Domestically produced Mo-99
To incentivize domestic production of Molybdenum-99 (Mo-99), CMS finalized a $10 add-on payment per dose of Technetium-99m derived from domestically produced, non–highly enriched uranium Mo-99, effective January 1, 2026.
The rule establishes a new HCPCS C-code (C9176) and clarifies that at least 50 percent of the Mo-99 used in the Tc-99m generator must be domestically produced for the dose to qualify for the add-on payment.
4. Hospital price transparency
CMS finalized several updates to Hospital Price Transparency regulations aimed at improving the accuracy and usability of machine-readable files. Beginning January 1, 2026, hospitals must include:
- Median, 10th and 90th percentile allowed amounts
- Counts of allowed amounts when negotiated charges are algorithm- or percentage-based
- CEO or senior official oversight identification
- Type 2 NPIs
Hospitals must also attest that pricing data is complete, accurate and current. CMS will delay enforcement of the new data elements until April 1, 2026.
In addition, CMS finalized a policy allowing a 35 percent reduction in civil monetary penalties under certain conditions when hospitals waive their right to an Administrative Law Judge hearing.
Together, these provisions underscore CMS’ continued focus on data transparency, cost accountability and targeted incentives within the outpatient payment system for 2026.
