Sponsors (2)
The bill simplifies billing and stabilizes hospital outpatient revenue by moving certain off‑campus services to the hospital OPPS, but that shift likely raises Medicare spending and patient cost‑sharing while reducing physician fee‑schedule revenue and creating uncertainty for small practices.
Hospitals and health systems: certain off‑campus outpatient services paid under the hospital OPPS will receive higher or more predictable payments, helping sustain low‑volume outpatient specialties and facilities.
Medicare beneficiaries: billing for qualifying off‑campus outpatient department services will be more consolidated and potentially clearer when billed under the hospital OPPS starting in 2027.
Providers and billing staff: using existing OPPS payment rules for qualifying off‑campus departments reduces site‑of‑service billing complexity and administrative burden for hospitals and affiliated provider organizations.
Taxpayers and Medicare program: shifting services to hospital OPPS is likely to increase Medicare spending if OPPS rates exceed prior physician fee schedule payments.
Medicare beneficiaries (patients): patients could face higher out‑of‑pocket cost‑sharing if hospital OPPS cost‑sharing rules result in larger patient payments than the physician fee schedule for the same services.
Physicians paid under the physician fee schedule: clinicians and smaller physician practices may lose service volume and associated revenue as services get billed under the hospital OPPS instead of the physician fee schedule.
Based on analysis of 2 sections of legislative text.
Beginning in 2027, certain services at off‑campus outpatient departments are paid under the hospital OPPS if the physician specialty’s prior‑year physician fee schedule payments for those services were under $2,000,000.
Official title: To amend title XVIII of the Social Security Act to allow payments under the Medicare program for certain items and services furnished by off-campus outpatient departments of a provider to be determined under the prospective payment system for hospital outpatient department services, and for other purposes.
Introduced February 24, 2026 by Adrian Smith · Last progress February 24, 2026
Treats certain items and services furnished at off-campus hospital outpatient departments as paid under the hospital outpatient prospective payment system (OPPS) beginning in 2027 when the physician specialty’s prior-year payments under the physician fee schedule for those services were below $2,000,000. The change targets low-volume physician specialties' services at off-campus outpatient departments so those services are included in OPPS payment determinations rather than being paid under the physician fee schedule for those specialties.