Federal Register: CMS Rules · November 6, 2026 · Primary source
Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; and Quality Reporting Programs; including the Hospital Outpatient Quality Reporting Program and Ambulatory Surgical Center Quality Program; Request for Information on Strengthening the Standardization and Comparability of Hospital Price Transparency (HPT) Data; Prior Authorization; Accrediting Organization (AO) Deeming for Emergency Medical Treatment and Labor Act (EMTALA); and Notices of Closure of Teaching Hospitals and Opportunities To Apply for Available Slots
Summary
CMS issued the final OPPS and ASC payment rule for calendar year 2027, revising payment rates and quality reporting requirements for hospital outpatient departments and ambulatory surgical centers. The rule expands prior authorization requirements to cover additional Botulinum Toxin Injection services and implements certain Consolidated Appropriations Act, 2026 provisions for off-campus outpatient departments. CMS also finalizes a policy permitting hospital accrediting organizations with deeming authority to assess compliance with specific EMTALA administrative requirements under 42 CFR 489.20 during accreditation surveys.
What this may mean
Hospital outpatient departments and ASCs face updated payment rates and revised quality reporting obligations effective calendar year 2027. The expansion of prior authorization to Botulinum Toxin Injection services creates new pre-service authorization workflows and potential claims denial exposure for affected providers. The EMTALA deeming policy integrates certain administrative compliance assessments into accreditation surveys, adding a formal audit pathway for EMTALA obligations at 42 CFR 489.20.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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