Sponsors (5)
The bill expands Medicare coverage and reduces cost‑sharing for certain office‑based surgical procedures—improving access and lowering patient costs—but increases Medicare spending and creates payment and administrative tradeoffs that could strain provider participation and program finances.
Medicare beneficiaries undergoing specified high‑supply surgical procedures in office‑based facilities will have lower facility coinsurance capped at the annual inpatient deductible, reducing their out‑of‑pocket costs.
Medicare patients, including those with chronic conditions, can access more procedures in office‑based settings covered under ASC payment rules, increasing convenience and access to ambulatory care.
Office‑based facilities that accept assignment receive a clear Medicare payment pathway (defined facility payments) to offer high‑supply procedures to Medicare patients, supporting provider participation in these settings.
Medicare program spending will increase because the program begins covering facility payments for more office‑based procedures and subsidizes beneficiary coinsurance, raising costs for taxpayers and the Trust Fund.
The policy reduces facility payments (to 90% of the ASC rate and 80% overall per the new rule), which may make offering these procedures less profitable for some providers and could discourage participation or shift costs elsewhere.
Annual rulemaking to add or remove covered procedures creates administrative complexity and year‑to‑year uncertainty for providers and beneficiaries about coverage and billing.
Based on analysis of 2 sections of legislative text.
Requires Medicare to cover and pay facility services for certain high supply cost surgical procedures in office-based facilities starting in 2027, with payments tied to ASC rates reduced and coinsurance capped.
Introduced March 9, 2026 by Gus Bilirakis · Last progress March 9, 2026
Expands Medicare coverage and payment rules so certain "high supply cost" surgical procedures performed in office-based facilities are treated like ambulatory surgical center (ASC) procedures for payment purposes beginning in 2027. It sets new payment formulas (with reductions relative to ASC rates), creates special rules for device‑intensive procedures, and caps beneficiary coinsurance for these facility services at the inpatient hospital deductible amount for the year.