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Health and Human Services Department, Centers for Medicare & Medicaid Services, Office of the Secretary

Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Rating; Hospital Price Transparency; and Notice of Closure of a Teaching Hospital and Opportunity To Apply for Available Slots

Published November 25, 2025. Takes effect January 1, 2026, printed at 90 FR 53448, amending 42 CFR 410, 42 CFR 412, 42 CFR 413, 42 CFR 415. 503,161 words.

In plain English

This sets what Medicare pays for care that does not need a hospital stay.

Read it at the Federal Register →

What the Rule Says It Does

This final rule with comment period revises the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2026 based on our continuing experience with these systems. We also describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment systems. In addition, this final rule with comment period announces the closure of a teaching hospital and the opportunity to apply for available slots, and updates and refines the requirements for the Hospital Outpatient Quality Reporting Program, Rural Emergency Hospital Quality Reporting Program, Ambulatory Surgical Center Quality Reporting Program, Overall Hospital Quality Star Rating, and hospitals to make public their standard charge information and enforcement of hospital price transparency, as well as summarizes comments received in response to a request for information on measure concepts regarding Well-Being and Nutrition for consideration in future years for the OQR, REHQR, and ASCQR programs.

This is the rule's own summary, as the Federal Register prints it.

The Orders It Names

The rule names these orders itself. What it does about them is a reading, and none is recorded here.

On the Face of the Rule

As filed

[Federal Register Volume 90, Number 225 (Tuesday, November 25, 2025)] [Rules and Regulations] [Pages 53448-54088] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 2025-20907]

Vol. 90

Tuesday,

No. 225

November 25, 2025

Part II

Department of Health and Human Services

Centers for Medicare & Medicaid Services

42 CFR Parts 410, 412, 413, et al.

45 CFR Part 180

Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Rating; Hospital Price Transparency; and Notice of Closure of a Teaching Hospital and Opportunity To Apply for Available Slots; Direct-Interim-Final Rule

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 410, 412, 413, 415, 416, and 419

Office of the Secretary

45 CFR Part 180

[CMS-1834-FC] RIN 0938-AV51

Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Rating; Hospital Price Transparency; and Notice of Closure of a Teaching Hospital and Opportunity To Apply for Available Slots

AGENCY

Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS).

ACTION

Final rule with comment period.

DATES

Effective Date: The provisions of this rule are effective January 1, 2026.

Comment period: To be assured consideration, comments must be received at one of the addresses provided below, by January 20, 2026.

Deadline for hospitals to submit applications for Available Resident Slots: Application submissions for Round 26 are due no later than February 19, 2026 (see section XXII.C. of this final rule with comment period for further details on the application process).

ADDRESSES

In commenting, please refer to file code CMS-1834-FC.

Comments, including mass comment submissions, must be submitted in one of the following three ways (please choose only one of the ways listed):

1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov. Follow the “Submit a comment” instructions.

2. By regular mail. You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1834-FC, P.O. Box 8010, Baltimore, MD 21244-8010.

Please allow sufficient time for mailed comments to be received before the close of the comment period.

3. By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1834-FC, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.

For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT

Regulation coordination questions, contact Gina Aughenbaugh via email at 410-786-7756 or [email protected].

Add-on Payment for Radiopharmaceutical Technetium-99m (Tc-99m) Derived from Domestically Produced Molybdenum-99, contact Au'Sha Washington via email at [email protected] or Leone Kisler at [email protected].

Adjusting Payment under the OPPS for Services Predominantly Performed in the ASC or Physician Office Settings Request for Information, contact Elise Barringer via email at [email protected].

Advisory Panel on Hospital Outpatient Payment (HOP Panel), contact the HOP Panel mailbox at [email protected].

Ambulatory Surgical Center Covered Procedures List (ASC CPL), contact Abigail Cesnik via email at [email protected].

Ambulatory Surgical Center Quality Reporting (ASCQR) Program measures, contact Marsha Hertzberg via email at [email protected].

Ambulatory Surgical Center Quality Reporting (ASCQR) Program policies, contact Anita Bhatia via email at [email protected].

All-Inclusive Rate (AIR) Add-On Payment for High-Cost Drugs Provided by Indian Health Service (IHS) and Tribal Facilities, contact Nate Vercauteren via email at [email protected].

Blood and Blood Products, contact Gil Ngan via email at [email protected].

Cancer Hospital Payments, contact Scott Talaga via email at [email protected].

CMS Web Posting of the OPPS and ASC Payment Files, contact Gil Ngan via email at [email protected].

Composite APCs (Multiple Imaging and Mental Health) and Comprehensive APCs (C-APCs), contact Elise Barringer via email at [email protected].

Device-Intensive Status and No Cost/Full Credit and Partial Credit Devices, contact Scott Talaga via email at [email protected].

Graduate Medical Education (GME) Accreditation, contact [email protected].

Hospital Outpatient Quality Reporting (OQR) Program policies, contact Kimberly Go via email at [email protected].

Hospital Outpatient Quality Reporting (OQR) Program measures, contact Kristina Rabarison via email at [email protected].

Hospital Outpatient Visits (Emergency Department Visits and Critical Care Visits), contact Elise Barringer via email at [email protected].

Hospital Price Transparency, contact Sarah Wheat via email at [email protected].

Inpatient Only (IPO) Procedures List, contact Abigail Cesnik via email at [email protected].

Market-Based Data Collection and Market-Based MS-DRG Relative Weight Methodology Issues, contact [email protected].

Medical Review of Certain Inpatient Hospital Admissions under Medicare Part A for CY 2026 and Subsequent Years (2-Midnight Rule), contact Nate Vercauteren via email at [email protected].

Medicare OPPS Drug Acquisition Cost Survey, contact Cory Duke via email at [email protected] or Gil Ngan at [email protected] or Nate Vercauteren at [email protected].

Method to Control Unnecessary Increases in the Volume of Outpatient Services, contact Elise Barringer via email at [email protected].

New Technology Intraocular Lenses (NTIOLs), contact Scott Talaga via email at [email protected].

Non-Opioid Policy or Implementation of Section 4135 of the Consolidated Appropriations Act (CAA), 2023, contact Cory Duke via email at [email protected] or Nicole Marcos via email at [email protected].

OPPS Brachytherapy, contact Cory Duke via email at [email protected] and Scott Talaga via email at [email protected].

OPPS Data (APC Weights, Conversion Factor, Copayments, Cost-to- Charge Ratios (CCRs), Data Claims, Geometric Mean Calculation, Outlier Payments, and Wage Index), contact Erick Chuang via email at [email protected] or Scott Talaga via email at [email protected].

OPPS Drugs, Radiopharmaceuticals, Biologicals, and Biosimilar Products, contact Gil Ngan via email at [email protected], Cory Duke via email at [email protected], or Nate Vercauteren via email at [email protected].

OPPS New Technology Procedures/Services, contact the New Technology APC mailbox at [email protected].

OPPS Packaged Items/Services, contact Cory Duke via email at [email protected].

OPPS Pass-Through Devices, contact the Device Pass-Through mailbox at [email protected].

OPPS Status Indicators (SI) and Comment Indicators (CI), contact Marina Kushnirova via email at [email protected] or Tonya Gierke at [email protected].

Overall Hospital Quality Star Rating policies, contact Tyson Nakashima Sr. via email [email protected].

Partial Hospitalization Program (PHP), Intensive Outpatient (IOP), and Community Mental Health Center (CMHC) Issues, contact the PHP Payment Policy Mailbox at [email protected].

Remote Services, contact Elise Barringer via email at [email protected] or Nate Vercauteren via email at [email protected].

Rural Emergency Hospital Quality Reporting (REHQR) Program policies, contact Anita Bhatia via email at [email protected].

Rural Emergency Hospital Quality Reporting (REHQR) Program measures, contact Melissa Hager via email at [email protected].

Skin Substitute Products, contact Susan Janeczko via email at [email protected], Cory Duke via email at [email protected], or Nicole Marcos via email at [email protected].

Software as a Service, contact Nicole Marcos via email at [email protected].

Virtual Direct Supervision of Outpatient Therapeutic and Diagnostic Services in Hospitals and CAHs, contact Nate Vercauteren via email at [email protected].

All Other Issues Related to Hospital Outpatient Payments Not Previously Identified, contact the OPPS mailbox at [email protected].

All Other Issues Related to the Ambulatory Surgical Center Payments Not Previously Identified, contact the ASC mailbox at [email protected].

The fields the Federal Register prints at the head of the rule, quoted as printed. Its summary is quoted above.

Why the Agency Says It Is Doing This

SUPPLEMENTARY INFORMATION

Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following website as soon as possible after they have been received: https://www.regulations.gov. Follow the search instructions on that website to view public comments. CMS will not post on Regulations.gov public comments that make threats to individuals or institutions or suggest that the individual will take actions to harm the individual. CMS continues to encourage individuals not to submit duplicative comments. We will post acceptable comments from multiple unique commenters even if the content is identical or nearly identical to other comments.

The passage that opens the rule's preamble, where the agency sets out what it is doing and on what authority. Every heading that follows it is listed below.

What the Rule Contains

Every heading the Federal Register prints in this rule, in the order it prints them. 246 headings, 503,161 words in all.

  1. AGENCYOn its face · 15 words
  2. ACTIONOn its face · 6 words
  3. SUMMARYOn its face · 168 words
  4. DATESOn its face · 74 words
  5. ADDRESSESOn its face · 154 words
  6. FOR FURTHER INFORMATION CONTACTOn its face · 770 words
  7. SUPPLEMENTARY INFORMATIONPreamble · 132 words
  8. Addenda Available Only Through the Internet on the CMS WebsitePreamble · 176 words
  9. I. Summary and BackgroundPreamble · 4 words
  10. A. Executive Summary of This DocumentPreamble · 6 words
  11. 1. PurposePreamble · 4,467 words
  12. B. Legislative and Regulatory Authority for the Hospital OPPSPreamble · 1,059 words
  13. C. Excluded OPPS Services and HospitalsPreamble · 309 words
  14. D. Prior RulemakingPreamble · 147 words
  15. E. Advisory Panel on Hospital Outpatient Payment (the HOP Panel or the Panel)Preamble · 13 words
  16. 1. Authority of the PanelPreamble · 809 words
  17. F. Public Comments Received on the CY 2026 OPPS/ASC ProposedPreamble · 114 words
  18. G. Public Comments Received on the CY 2025 OPPS/ASC Final Rule With Comment PeriodPreamble · 45 words
  19. II. Updates Affecting OPPS PaymentsPreamble · 5 words
  20. A. Recalibration of APC Relative Payment WeightsPreamble · 22,791 words
  21. B. Final Conversion Factor UpdatePreamble · 5 words
  22. 1. OPD Fee Schedule Increase FactorPreamble · 2,915 words
  23. C. Wage Index ChangesPreamble · 4,961 words
  24. D. Final Statewide Average Default Cost-to-Charge Ratios (CCRs)Preamble · 1,208 words
  25. F. Payment Adjustment for Certain Cancer Hospitals for CY 2026Preamble · 10 words
  26. 1. BackgroundPreamble · 737 words
  27. 2. Policy for CY 2026Preamble · 1,694 words
  28. G. Hospital Outpatient Outlier PaymentsPreamble · 5 words
  29. 1. BackgroundPreamble · 1,756 words
  30. H. Calculation of an Adjusted Medicare Payment From the National Unadjusted Medicare PaymentPreamble · 1,955 words
  31. I. Beneficiary CopaymentsPreamble · 3 words
  32. 1. BackgroundPreamble · 3,961 words
  33. III. OPPS Ambulatory Payment Classification (APC) Group PoliciesPreamble · 8 words
  34. A. OPPS Treatment of New and Revised HCPCS CodesPreamble · 1,368 words
  35. 3. October 2025 HCPCS Codes Final Rule Comment SolicitationPreamble · 1,562 words
  36. B. OPPS Changes--Variations Within APCsPreamble · 5 words
  37. 1. BackgroundPreamble · 2,062 words
  38. C. New Technology APCsPreamble · 4 words
  39. 1. BackgroundPreamble · 3,717 words
  40. b. BgRT (APC 1521 and 1525)Preamble · 1,173 words
  41. c. Blinded Procedure for NYHA Class III/IV Heart Failure (APC 1590)Preamble · 678 words
  42. d. Bronchoscopy With Transbronchial Ablation of Lesion(s) by Microwave Energy (APC 1562)Preamble · 498 words
  43. e. Cardiac Positron Emission Tomography (PET)/Computed Tomography (CT) Studies (APCs 1519 and 1522)Preamble · 1,661 words
  44. g. Atherosclerosis Imaging-Quantitative Computer Tomography (AI-QCT) (APC 1511)Preamble · 1,636 words
  45. h. Corvia Medical Interatrial Shunt Procedure (APC 1592)Preamble · 557 words
  46. i. DARI Motion Procedure (APC 1505)Preamble · 291 words
  47. j. Instillation of Anti-Neoplastic Pharmacologic/Biologic Agent Into Renal Pelvis (APC 1551)Preamble · 894 words
  48. k. LimFlow TADV Procedure CPT Code 0620T (APC 1580)Preamble · 823 words
  49. l. Liver Histotripsy Service (APC 1579)Preamble · 764 words
  50. m. LiverMultiScan Service (APC 1511)Preamble · 961 words
  51. n. Optellum Lung Cancer Prediction (LCP) (APC 1508)Preamble · 2,021 words
  52. p. Quantitative Magnetic Resonance Cholangiopancreatography (QMRCP) (APC 1511)Preamble · 518 words
  53. q. Supervised Visits for Esketamine Self-Administration (APCs 1512 and 1518)Preamble · 1,075 words
  54. r. Surfacer[supreg] Inside-Out[supreg] Access Catheter System (APC 1534)Preamble · 320 words
  55. s. Transcatheter Atrial Shunt System (TASS) (APC 1537)Preamble · 388 words
  56. t. Magnetic Resonance Imaging With Inhaled Hyperpolarized Xenon-129 Contrast Agent (APC 1551)Preamble · 396 words
  57. u. SAINT Neuromodulation System (APCs 1511 and 1525)Preamble · 1,829 words
  58. w. Skin Cell Suspension Autograft (SCSA) Procedures (CPT Code 15013 and HCPCS Code C8002) (APC 1567)Preamble · 453 words
  59. x. Renal Histotripsy Service (APC 1576)Preamble · 495 words
  60. D. Universal Low Volume APC Policy for Clinical and Brachytherapy APCsPreamble · 587 words
  61. E. APC-Specific PoliciesPreamble · 4,476 words
  62. 6. Lymphovenous Bypass, CPT Code 1019T (APC 5092)Preamble · 2,274 words
  63. 8. Cardiac Magnetic Resonance (CMR) Imaging, CPT Codes 75557, 75559, 75561, 75563 (APCs 5523, 5524, 5572, and 5573)Preamble · 856 words
  64. 9. Computational Electrocardiogram (ECG) Analysis System (vMap), CPT Code 0897T (APC 5724)Preamble · 591 words
  65. 10. Fractional Flow Reserve Derived From Computed Tomography (FFRct) CPT Code 75580 (APC 5724)Preamble · 746 words
  66. 11. Chimeric Antigen Receptor (CAR-T) Administration, CPT Codes 38228 (APC 5694)Preamble · 912 words
  67. 12. CVi[supreg] Contrast Delivery SystemPreamble · 848 words
  68. 15. Endoscopic Procedure--Upper GI Tract, CPT Code 43252 (APC 5302)Preamble · 309 words
  69. 16. Endoscopic Retrograde Cholangiopancreatography (ERCP) With Stone Destruction Procedure, CPT Code 43265 (APC 5331)Preamble · 260 words
  70. 17. Endoscopic Submucosal Dissection (ESD) Procedure, HCPCS Code C9779 (APC 5303)Preamble · 503 words
  71. 18. Esophageal Balloon Distention Study, CPT Code 91040 (APC 5723)Preamble · 420 words
  72. 19. Transnasal EGD, CPT Codes 0652T, 0653T, and 0654T (APCs 5302 and 5303)Preamble · 1,890 words
  73. 23. Computed Tomographic Services (Head, Neck, and Cerebral Perfusion), CPT Codes 70471 and 70473 (APCs 5572, 5571)Preamble · 575 words
  74. 24. Duplex Scan of Extracranial Arteries, CPT Code 93880 (APC 5523)Preamble · 1,065 words
  75. 27. Irreversible Electroporation Ablation of Tumors (NanoKnife[supreg] System), CPT Codes 0600T, 47384, 55877 (APC 5362)Preamble · 927 words
  76. Laboratory Related ServicesPreamble · 1,495 words
  77. 32. Medical 3D Printing, CPT Codes 0559T, 0561T (5734)Preamble · 1,113 words
  78. 34. Transcutaneous Magnetic Peripheral Nerve Stimulation CPT Codes 0766T and 0767T (APC 5722)Preamble · 595 words
  79. 35. Ultrasound Guided Carpal Tunnel Release Procedure, CPT Code 64728 (APC 5431)Preamble · 6,292 words
  80. 41. Nuclear Medicine Study (1 Area), CPT Code 78800 (APC 5591)Preamble · 2,486 words
  81. 45. Fusion of Foot Bones, CPT Code 28740 (APC 5114)Preamble · 1,709 words
  82. 47. Radiofrequency Ablation of Bone Tumors, CPT 20982 (APC 5116)Preamble · 427 words
  83. 48. Scalp Cooling, CPT Codes 97007, 97008, and 97009 (APC 1517)Preamble · 1,693 words
  84. 50. Insertion of Endobronchial Valves, CPT Code 31647 (APC 5155)Preamble · 644 words
  85. 51. Non-Invasive Gas Exchange and Cardiorespiratory Status (AGM 100), CPT Code 0893T (APC 5734)Preamble · 1,591 words
  86. 54. Augmentative Analysis of CT Imaging Data for Interstitial Lung Disease, CPT Code 0877T (APC 1508)Preamble · 1,772 words
  87. 57. Enhanced Lithotripsy System, CPT Code 0991T (APC 5376)Preamble · 726 words
  88. 58. Insertion of Permanent Urethral Stent, CPT Code 52282 (APC 5374)Preamble · 756 words
  89. 59. Penile Prosthesis, CPT Code 54417 (APC 5377)Preamble · 512 words
  90. 60. Prostate Biopsy Codes, CPT Codes 55712, 55713, 55714, and 55715Preamble · 415 words
  91. 61. Ureteroscopy, HCPCS Code C9761 (APC 5376)Preamble · 1,327 words
  92. 64. Atherectomy With Angioplasty, CPT Code 92924 (APC 5193)Preamble · 406 words
  93. 65. Coronary Therapeutic Services and Procedures CPT Codes 92930, 92945 (APCs 5194, 5193)Preamble · 741 words
  94. 66. Lower Extremity Revascularization, CPT Codes 37254 Through 37299 (APCs 5192, 5193, and 5194)Preamble · 1,114 words
  95. 68. APC Specific Comments That Support the Proposed APC AssignmentPreamble · 686 words
  96. c. Open Surgical Fistula CreationPreamble · 724 words
  97. F. Comment Solicitation on Payment Policy for Software as a Service (SaaS)Preamble · 1,570 words
  98. G. Continuation of Payment Policy for Radiation Therapy Services Furnished at Nonexcepted Off-Campus Provider Based Departments (PBDs)Preamble · 17 words
  99. 1. Background on Section 603 of the Bipartisan Budget Act of 2015 and the PFS Relativity AdjusterPreamble · 1,934 words
  100. IV. OPPS Payment for DevicesPreamble · 5 words
  101. A. Pass-Through Payment for DevicesPreamble · 33,926 words
  102. B. Device-Intensive ProceduresPreamble · 3 words
  103. 1. BackgroundPreamble · 9,044 words
  104. V. OPPS Payment for Drugs, Biologicals, and RadiopharmaceuticalsPreamble · 8 words
  105. A. OPPS Transitional Pass-Through Payment for Additional Costs of Drugs, Biologicals, and RadiopharmaceuticalsPreamble · 13 words
  106. 1. BackgroundPreamble · 4,487 words
  107. B. OPPS Payment for Drugs, Biologicals, and Radiopharmaceuticals Without Pass-Through Payment StatusPreamble · 8,112 words
  108. 3. Payment Policy for RadiopharmaceuticalsPreamble · 1,528 words
  109. 4. Payment for Blood Clotting FactorsPreamble · 262 words
  110. 5. Payment for Nonpass-Through Drugs, Biologicals, and Radiopharmaceuticals With HCPCS Codes But Without OPPS Hospital Claims DataPreamble · 976 words
  111. b. Payment for 340B Drugs and Biologicals in CYs 2018 Through 2022Preamble · 1,199 words
  112. e. Payment for 340B-Acquired Drug Claims for September 28, 2022 Through CY 2025Preamble · 12,428 words
  113. i. Impact of the Prospective Offset to the OPPS Conversion Factor on the ASC Payment SystemPreamble · 7,500 words
  114. d. Payment of Skin Substitute Products Under the PFS and OPPS 1. Payment for Skin Substitute Products as Incident-to SuppliesPreamble · 6,750 words
  115. b. Devices Requiring 510(k) ClearancePreamble · 14,468 words
  116. 5. SummaryPreamble · 5,738 words
  117. C. Notice of Intent To Conduct Medicare OPPS Drugs Acquisition Cost SurveyPreamble · 12,971 words
  118. VI. Estimate of OPPS Transitional Pass-Through Spending for Drugs, Biologicals, Radiopharmaceuticals, and DevicesPreamble · 13 words
  119. A. Amount of Additional Payment and Limit on Aggregate Annual AdjustmentPreamble · 1,318 words
  120. B. Final Estimate of Pass-Through Spending for CY 2026Preamble · 2,852 words
  121. VII. OPPS Payment for Hospital Outpatient Visits and Critical Care ServicesPreamble · 522 words
  122. VIII. Payment for Partial Hospitalization and Intensive Outpatient ServicesPreamble · 101 words
  123. A. BackgroundPreamble · 2 words
  124. 1. Partial HospitalizationPreamble · 2,808 words
  125. B. Coding and Billing for PHP and IOP Services Under the OPPSPreamble · 977 words
  126. C. CY 2026 Payment Rates for PHP and IOPPreamble · 1,659 words
  127. 3. CY 2026 Payment Rate Methodology for PHP and IOPPreamble · 3,936 words
  128. D. Outlier Policy for CMHCsPreamble · 1,403 words
  129. IX. Services That Will Be Paid Only as Inpatient ServicesPreamble · 10 words
  130. A. BackgroundPreamble · 895 words
  131. B. Current Methodology for Identifying Appropriate Changes to the IPO ListPreamble · 643 words
  132. C. CY 2026 Changes to IPO ListPreamble · 7 words
  133. 1. CY 2026 Proposal To Eliminate the IPO ListPreamble · 8,639 words
  134. X. Nonrecurring Policy ChangesPreamble · 4 words
  135. A. Method To Control Unnecessary Increases in the Volume of Outpatient Services Furnished in Excepted Off-Campus Provider-Based Departments (PBDs)Preamble · 19 words
  136. 1. BackgroundPreamble · 4,540 words
  137. 6. Impact of Unnecessary Increases in Volume on the OPPSPreamble · 22,996 words
  138. D. Medical Review of Certain Inpatient Hospital Admissions Under Medicare Part A for CY 2026 and Subsequent YearsPreamble · 18 words
  139. 1. Background on the 2-Midnight RulePreamble · 5,184 words
  140. E. Coding and Payment for Category B IDE Devices and StudiesPreamble · 418 words
  141. XI. CY 2026 OPPS Payment Status and Comment IndicatorsPreamble · 9 words
  142. A. CY 2026 OPPS Payment Status Indicator DefinitionsPreamble · 307 words
  143. B. CY 2026 Comment Indicator DefinitionsPreamble · 296 words
  144. XII. MedPAC RecommendationsPreamble · 134 words
  145. A. OPPS Payment Rates UpdatePreamble · 109 words
  146. B. Medicare Safety Net IndexPreamble · 155 words
  147. XIII. Updates to the Ambulatory Surgical Center (ASC) Payment SystemPreamble · 10 words
  148. A. Background, Legislative History, Statutory Authority, and Prior Rulemaking for the ASC Payment SystemPreamble · 159 words
  149. B. ASC Treatment of New and Revised CodesPreamble · 8 words
  150. 1. Background on Process for New and Revised HCPCS CodesPreamble · 1,408 words
  151. 3. July 2025 HCPCS Codes Proposed Rule Comment SolicitationPreamble · 325 words
  152. 4. October 2025 HCPCS Codes Final Rule Comment SolicitationPreamble · 2,050 words
  153. C. Payment Policies Under the ASC Payment SystemPreamble · 10,836 words
  154. D. Final Additions to ASC Covered Surgical Procedures and Covered Ancillary Services ListsPreamble · 13 words
  155. 1. Current Review Process for the List of ASC Covered Surgical ProceduresPreamble · 5,211 words
  156. 3. Covered Ancillary ServicesPreamble · 765 words
  157. E. Skin Substitute Changes to the List of ASC Covered Items and Services for CY 2026Preamble · 482 words
  158. F. Final CY 2026 Non-Opioid Policy for Pain Relief Under the OPPS and ASC Payment SystemPreamble · 16 words
  159. 1. BackgroundPreamble · 6,702 words
  160. SapphireTM Multi-Therapy Infusion SystemPreamble · 580 words
  161. AvosetTM Infusion SystemPreamble · 3,698 words
  162. Altius SystemPreamble · 402 words
  163. Reactiv8 Implantable Neurostimulation SystemPreamble · 391 words
  164. Game Ready SystemPreamble · 1,911 words
  165. G. New Technology Intraocular Lenses (NTIOLs)Preamble · 772 words
  166. H. Calculation of the ASC Payment Rates and the ASC Conversion FactorPreamble · 12 words
  167. 1. BackgroundPreamble · 7,201 words
  168. A. BackgroundPreamble · 1,221 words
  169. C. Changes to the Hospital OQR, REHQR, and ASCQR Program Measure SetsPreamble · 6,119 words
  170. D. Updates to the Extraordinary Circumstances Exception (ECE) Policy for the Hospital OQR, REHQR, and ASCQR ProgramsPreamble · 17 words
  171. 1. BackgroundPreamble · 1,947 words
  172. XV. Hospital Outpatient Quality Reporting (OQR) ProgramPreamble · 7 words
  173. A. Background and History of the Hospital OQR ProgramPreamble · 176 words
  174. B. Changes to the Hospital OQR Program Measure SetPreamble · 1,676 words
  175. c. Measure CalculationPreamble · 1,951 words
  176. e. Measure EndorsementPreamble · 249 words
  177. f. Data Collection, Submission, and ReportingPreamble · 11,316 words
  178. C. Updates to the Form, Manner, and Timing of Hospital OQR Program Data SubmissionPreamble · 14 words
  179. 1. Background on Data Submission and Reporting Requirements for eCQMsPreamble · 406 words
  180. D. Payment Reduction for Hospitals That Fail To Meet the Hospital OQR Program Requirements for the CY 2026 Payment DeterminationPreamble · 20 words
  181. 1. BackgroundPreamble · 1,643 words
  182. XVI. Rural Emergency Hospital Quality Reporting (REHQR) ProgramPreamble · 8 words
  183. A. Background and History of the REHQR ProgramPreamble · 205 words
  184. B. Changes to the REHQR Program Measure SetPreamble · 3,627 words
  185. e. Measure Endorsement and Consideration of Low Case VolumesPreamble · 3,734 words
  186. C. Updates to the Form, Manner, and Timing of REHQR Program Data SubmissionPreamble · 3,323 words
  187. XVII. Ambulatory Surgical Center Quality Reporting (ASCQR) ProgramPreamble · 8 words
  188. A. Background and History of the ASCQR ProgramPreamble · 236 words
  189. B. Changes to the ASCQR Program Measure SetPreamble · 681 words
  190. b. Measure OverviewPreamble · 725 words
  191. c. Measure CalculationPreamble · 210 words
  192. d. Pre-Rulemaking Measure Review (PRMR)Preamble · 1,210 words
  193. f. Data Collection, Submission, and ReportingPreamble · 7,545 words
  194. C. Updates to the Form, Manner, and Timing of ASCQR Program Data SubmissionPreamble · 1,526 words
  195. D. Payment Reduction for ASCs That Fail To Meet the ASCQR Program RequirementsPreamble · 13 words
  196. 1. Statutory BackgroundPreamble · 1,255 words
  197. XVIII. Overall Hospital Quality Star Rating Modification To Emphasize the Safety of Care Measure GroupPreamble · 15 words
  198. A. SummaryPreamble · 311 words
  199. B. BackgroundPreamble · 430 words
  200. C. Current Overall Hospital Quality Star Rating Methodology (Sec. 412.190)Preamble · 439 words
  201. D. Modification to the Overall Hospital Quality Star Rating MethodologyPreamble · 9,977 words
  202. XIX. Updates to Requirements for Hospitals to Make Public a List of Their Standard ChargesPreamble · 15 words
  203. A. Introduction and OverviewPreamble · 4 words
  204. 1. Statutory Basis and BackgroundPreamble · 2,111 words
  205. B. Modifications to the Requirements for Making Public Hospital Standard Charges at 45 CFR 180.50Preamble · 27,464 words
  206. C. Improved and Enhanced EnforcementPreamble · 5 words
  207. 1. BackgroundPreamble · 3,150 words
  208. A. OverviewPreamble · 1,286 words
  209. B. Factors ConsideredPreamble · 2,392 words
  210. C. Market-Based MS-DRG Relative Weight EstimationPreamble · 6 words
  211. 1. OverviewPreamble · 9,647 words
  212. XXI. Graduate Medical Education AccreditationPreamble · 5 words
  213. A. Executive Order 14279Preamble · 480 words
  214. B. Definition of “Approved Medical Residency Programs”Preamble · 2,846 words
  215. A. BackgroundPreamble · 322 words
  216. B. Notice of Closure of Pontiac General Hospital Located in Pontiac, MI, and the Application Process--Round 26Preamble · 115 words
  217. C. Application Process for Available Resident SlotsPreamble · 300 words
  218. XXIII. Collection of Information RequirementsPreamble · 151 words
  219. A. ICRs for the Hospital Outpatient Quality Reporting (OQR) ProgramPreamble · 10 words
  220. 1. BackgroundPreamble · 3,804 words
  221. B. ICRs for the Rural Emergency Hospital Quality Reporting (REHQR) ProgramPreamble · 11 words
  222. 1. BackgroundPreamble · 2,244 words
  223. C. ICRs for the Ambulatory Surgical Center Quality Reporting (ASCQR) ProgramPreamble · 11 words
  224. 1. BackgroundPreamble · 2,003 words
  225. D. Summary of Information Collection Burden Estimates for the Overall Hospital Quality Star RatingPreamble · 127 words
  226. E. ICRs for Payer-Specific Negotiated Charges Data CollectionPreamble · 2,964 words
  227. F. ICRs for Medicare OPPS Drug Acquisition Cost SurveyPreamble · 9 words
  228. a. BackgroundPreamble · 380 words
  229. b. OPPS Drug Acquisition Cost Survey Description and Burden CalculationPreamble · 1,892 words
  230. G. ICRs for Hospital Price TransparencyPreamble · 4,558 words
  231. XXIV. Files Available to the Public via the InternetPreamble · 690 words
  232. XXV. Response to CommentsPreamble · 70 words
  233. XXVI. Economic AnalysesPreamble · 3 words
  234. A. Statement of NeedPreamble · 614 words
  235. B. Overall Impact of Provisions of This Final Rule With Comment PeriodPreamble · 845 words
  236. C. Detailed Economic AnalysesPreamble · 3,526 words
  237. d. Estimated Effects of OPPS Changes on CMHCsPreamble · 2,380 words
  238. c. Estimated Effects of ASC Payment System Policies on BeneficiariesPreamble · 3,616 words
  239. 7. Effects of a Final Market-Based MS-DRG Relative Weight MethodologyPreamble · 4,612 words
  240. D. Regulatory Review Cost EstimationPreamble · 306 words
  241. E. Regulatory Flexibility Act (RFA) AnalysisPreamble · 484 words
  242. F. Unfunded Mandates Reform Act (UMRA)Preamble · 96 words
  243. G. FederalismPreamble · 263 words
  244. H. E.O. 14192, “Unleashing Prosperity Through Deregulation”Preamble · 121 words
  245. XXVII. Waiver of 60-Day Delay of Effective DatePreamble · 775 words
  246. List of SubjectsRegulatory text · 7,074 words

The Rest of the Text

This rule runs to 503,161 words. The rest of it is set out over 29 pages, split at the rule's own headings so that no heading is parted from the words printed under it.

How to cite this
  1. The rule itself

    Health and Human Services Department, Centers for Medicare & Medicaid Services, Office of the Secretary, “Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Rating; Hospital Price Transparency; and Notice of Closure of a Teaching Hospital and Opportunity To Apply for Available Slots,” 90 FR 53448 (November 25, 2025). Effective January 1, 2026.
    https://www.federalregister.gov/documents/2025/11/25/2025-20907/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment

  2. This page

    “Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Rating; Hospital Price Transparency; and Notice of Closure of a Teaching Hospital and Opportunity To Apply for Available Slots,” a final rule naming an order indexed here. Read the Mandate, https://readthemandate.org/rules/rule-2025-20907/ (retrieved October 10, 2026).

Cite the document when the claim is about what the document says. Cite this page when the indexing, the wording or the record of what has happened is what is being relied on.

How This Rule Is Set Out

Federal Register documents are United States government works and are not under copyright, so the rule is here whole rather than cut to an excerpt. It is split at the headings the Register itself prints: the line it is filed under, the captioned fields on its face, the preamble where the agency says what it is doing and why, and the amendments to the Code of Federal Regulations. No passage is shortened. This rule is long enough that its text is set out over 29 pages rather than one.

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