Sponsors (2)
The bill shifts certain off‑campus outpatient payments toward hospital OPPS reimbursement—reducing some Medicare beneficiaries' out‑of‑pocket costs and stabilizing hospital revenue while raising program spending, encouraging site‑of‑care shifts that can increase prices for patients, and reducing some physicians' professional payments.
Medicare beneficiaries will often pay lower out-of-pocket costs for certain off‑campus outpatient services when those services are reimbursed under the hospital outpatient prospective payment system (OPPS).
Hospitals with qualifying off‑campus outpatient departments will receive higher and more predictable OPPS payments for low‑volume physician‑specialty services, improving revenue stability for those hospital departments.
Medicare program spending could increase because OPPS rates are often higher than physician fee schedule rates, potentially raising taxpayer costs or putting pressure on Medicare finances.
Patients (including those with chronic conditions) may face incentives for services to shift to hospital‑owned off‑campus sites, which can lead to higher overall health care prices and confusing changes in billing or site‑of‑care.
Physicians in specialties with under $2 million in prior‑year payments could see reduced professional fee payments if services move from the physician fee schedule to OPPS, lowering their revenue.
Based on analysis of 2 sections of legislative text.
Starting in 2027, Medicare payments for certain services at off‑campus outpatient departments must be made under OPPS when the top physician specialty for those services had under $2M in prior‑year PFS payments.
Introduced February 25, 2026 by John Hoeven · Last progress February 25, 2026
Beginning in 2027, Medicare payments for certain items and services provided at off‑campus outpatient departments will be paid under the hospital outpatient prospective payment system (OPPS) instead of the physician fee schedule when the physician specialty with the largest prior‑year physician fee schedule payments for those services had under $2,000,000 in payments. The rule applies only when the items/services are furnished by an off‑campus outpatient department as defined in existing law and the specified payment threshold is met. The change targets a narrow set of services tied to low‑volume physician specialties and shifts payment methodology from physician fee schedule rates to hospital OPPS rates for those services starting in 2027. It may change revenue and billing practices for hospitals, outpatient departments, and physicians and could affect Medicare spending and beneficiary cost-sharing depending on how OPPS rates compare to prior payments.