CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule (CMS-1834-FC)
Hospital Price Transparency Policy Changes
Consistent with the President’s Executive Order 14221, “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information,” on November 21, 2025, the Centers for Medicare & Medicaid Services (CMS) finalized changes to the hospital price transparency regulations to ensure that hospitals provide meaningful, accurate information about the amount they charge for health care items and services.
The policies in the final rule will further advance the agency’s commitment to ensure patients have the information they need to make well-informed healthcare decisions by requiring the disclosure of actual prices and ensure pricing information is easily comparable across hospitals. This fact sheet discusses the hospital price transparency final provisions of the calendar year 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center final rule (CMS-1834-FC), which can be downloaded from the Federal Register at: https://www.federalregister.gov/documents/current.
Enhancing Clarity and Standardization of Hospital Standard Charges
Replacing the Estimated Allowed Amount with the Allowed Amounts Data Elements and the Count of Allowed Amounts Data Element
To further transparency and the comparability of hospital pricing information, CMS is finalizing requirements for hospitals to make public actual dollar amounts in their machine-readable file (MRF). Specifically, we are finalizing the requirement to replace the estimated allowed amount with the median allowed amount and to add the 10th and 90th percentile allowed amounts. When a payer-specific negotiated charge is based on a percentage or algorithm, hospitals will be required to encode the median allowed amount and the 10th and 90th percentile allowed amount in dollars. The hospital will also be required to calculate and encode the count of allowed amounts that were used to calculate the median, 10th and 90th percentile allowed amount data elements.
CMS is finalizing the requirement that hospitals use electronic data interchange (EDI) 835 electronic remittance advice (ERA) or an alternative, equivalent source of remittance data to calculate and encode the median, 10th and 90th percentile allowed amounts as well as the count of allowed amounts. Should the calculated amount for the median, 10th and 90th percentile allowed amounts fall between two observed allowed amounts, hospitals are instructed to use the next highest observed value. Finally, CMS is finalizing the requirement that hospitals use a lookback period of no less than 12 months and no longer than 15 months prior to posting the machine-readable file (MRF) for the median allowed amount, 10th and 90th percentile allowed amounts, and count of allowed amounts.
Modification to the MRF Affirmation Statement
CMS is finalizing regulations at 45 CFR § 180.50 which require hospitals to attest in the MRF that, to the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of § 180.50 and that the information encoded is true, accurate, and complete as of the date in the file. The attestation also states that the hospital has included all applicable payer-specific negotiated charges in dollars that can be expressed as a dollar amount, and for payer-specific negotiated charges that cannot be expressed as a dollar amount in the MRF or are not knowable in advance, the hospital has provided in the MRF all necessary information available to the hospital for the public to be able to derive a dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm, or formula. Furthermore, hospitals will be required to encode in the MRF the name of the hospital chief executive officer, president, or senior official designated to oversee the encoding of true, accurate, and complete data.
Including the National Provider Identifier(s) in the MRFs
Executive Order 14221 directs HHS to ensure that pricing information is standardized and easily comparable across hospitals and health plans. To advance the comparability of HPT information with other healthcare data, CMS is finalizing the requirement that hospitals encode their organizational, or Type 2, National Provider Identifier(s) (NPIs) in the MRFs. Hospitals will be required to report, in a newly created general data element in the MRF, any Type 2 NPI(s) that is associated with primary taxonomy code starting with ‘28’ (indicating hospital) or ‘27’ (indicating hospital unit) and that is active as of the date of the most recent update to the standard charge information.
Civil Monetary Penalties: Waiver of Hearing, Automatic Reduction of Penalty Amount
To encourage faster resolution and payment of Civil Monetary Penalties (CMPs), and in acceptance of CMS’s determination that the hospital violated HPT requirements, CMS will update § 180.90 to reduce the amount of a CMP by 35 percent when a hospital waives its right to an ALJ hearing. However, there are certain situations where CMS will decline to make available to hospitals the opportunity to have a CMP amount reduced. We are finalizing a policy stating that if CMS imposes upon a hospital a CMP for HPT noncompliance going to the core of the HPT requirements, the hospital would be ineligible to avail itself of this opportunity. CMS has specified these core requirements as failing to make public either: (1) an MRF as required in § 180.40(a); or (2) any shoppable services in a consumer-friendly format (either in the form of a shoppable services file or an internet price estimator tool) as required by § 180.40(b). These revisions will be effective January 1, 2026.
Effective Dates
The effective date of the revisions at § 180.50, including removal of the estimated allowed amount, disclosure of the median, 10th, and 90th percentile allowed amounts and the count of allowed amounts, the attestation requirement, and the requirement that hospitals encode their organizational, or Type 2, NPIs in the MRFs will be January 1, 2026. However, CMS will delay enforcement of these finalized revisions until April 1, 2026. This 3-month enforcement delay will apply solely to enforcement actions based on the new CMS requirements at revised § 180.50. CMS believes this 3-month enforcement delay will provide hospitals with sufficient time to update their systems, and review, validate, and post their files.
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