CMS publishes CY 2027 OPPS final rule

CMS released the calendar year (CY) 2027 Outpatient Prospective Payment System (OPPS) final rule, outlining updates to Medicare reimbursement rates and policies for hospital outpatient services in the coming year.

CMS finalized a 2.3% increase to OPPS payment rates for hospitals that meet applicable quality reporting requirements. This increase is based on a projected hospital market basket percentage increase of 3.2%, offset by a 0.9 percentage point productivity adjustment.

One of the major provisions in the 2027 OPPS proposed rule called for reducing reimbursement for 340B-acquired drugs to the average sales price (ASP) minus 33%. CMS finalized a slightly higher reimbursement rate of ASP minus 28%, which is expected to reduce original Medicare drug payments by $4.35 billion in the first year.

To maintain budget neutrality, CMS increased the prospective reduction to the OPPS conversion factor for non-drug services from 0.5% to 2.0%. This adjustment excludes hospitals enrolled in Medicare after January 1, 2018, and is intended to recover $7.8 billion in prior overpayments by 2031, according to the agency.

Other key provisions in the final rule include the following:

• Reducing reimbursement for certain imaging services furnished without contrast in excepted off-campus provider-based departments to the Medicare Physician Fee Schedule rate
• Removing 637 procedures from the inpatient-only list
• Requiring prior authorization for eight additional botulinum toxin injection codes

Revenue cycle professionals can read CMS’ fact sheet and press release on the CY 2027 OPPS final rule for more information.