CMS issues CY 2027 OPPS proposed rule

CMS recently published the calendar year (CY) 2027 Outpatient Prospective Payment System (OPPS) proposed rule, outlining its plans to update Medicare outpatient payment rates and policies. Overall, CMS is proposing to update OPPS payment rates by 2.4% for CY 2027.

One of the key proposals in the rule is to pay for certain imaging services without contrast furnished in excepted off-campus provider-based departments at the Medicare Physician Fee Schedule-equivalent rate, rather than the higher OPPS rate. This policy is intended to expand site-neutral payments, but rural sole community hospitals would be exempt, according to CMS.

Based on data it collected during the Outpatient Drug Acquisition Cost Survey earlier this year, CMS is proposing to significantly reduce payments for 340B drugs. While the agency currently pays for 340B drugs at the average sales price (ASP) plus 6%, it is proposing to reimburse these drugs at ASP minus 33.4% starting in CY 2027. CMS has had its sights set on reducing 340B payment rates for years, but its previous controversial attempt was ultimately vacated by the Supreme Court. Similar to last time, the American Hospital Association and other industry stakeholders strongly oppose the proposal.

The proposed rule also calls for extensive cuts to the inpatient-only (IPO) list. In the CY 2026 OPPS final rule, CMS initiated a three-year elimination of the IPO list by removing 285 mostly musculoskeletal procedures. Now, it is proposing to cut 637 procedures in CY 2027, including certain digestive, endocrine, and maternity care services. If finalized, this proposal would leave roughly 800 procedures on the list ahead of the final transition year.

The CY 2027 OPPS proposed rule also details potential updates to quality programs, prior authorization, pass-through payments, and more. Comments on the rule are due by August 31, 2026. Revenue cycle staff can view CMS’ fact sheet and press release for more information.