Sponsors (2)
The bill simplifies and consolidates payment/billing for certain off‑campus outpatient services—helping hospitals and reducing provider paperwork and patient billing confusion—but shifts costs toward Medicare and patients and can reduce physician fee‑schedule revenue while creating uncertainty for small specialties.
Hospitals and health systems could receive higher or more predictable payments for certain off‑campus outpatient services as those services shift to the hospital OPPS, supporting the financial sustainability of low‑volume outpatient specialties.
Medicare beneficiaries may get clearer, consolidated billing for qualifying off‑campus outpatient services when payment is made under the hospital OPPS starting in 2027, simplifying what they see on statements.
Providers (hospitals, clinics, and billing staff) may face reduced administrative complexity by applying existing OPPS payment rules instead of navigating multiple site‑of‑service billing regimes for qualifying off‑campus departments.
Taxpayers and the Medicare program may face higher spending if hospital OPPS payment rates exceed prior physician fee schedule payments for these services, increasing federal program costs.
Medicare beneficiaries could face higher out‑of‑pocket cost‑sharing if hospital OPPS cost‑sharing is higher than the physician fee schedule for the same services.
Physicians paid under the physician fee schedule—particularly specialists—may lose fee‑schedule volume and revenue as services shift to hospital billing under OPPS.
Based on analysis of 2 sections of legislative text.
Shifts payment for certain services at off‑campus outpatient departments to OPPS when a physician specialty’s prior‑year fee‑schedule payments for those services were under $2,000,000.
Introduced February 24, 2026 by Adrian Smith · Last progress February 24, 2026
Amends Medicare payment rules so that, beginning in 2027, items and services furnished at certain off‑campus outpatient departments will be paid under the hospital outpatient prospective payment system (OPPS) 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 and shifts how Medicare pays for services furnished at provider‑based off‑campus outpatient locations.