On Nov. 21, 2025, the Centers for Medicare & Medicaid Services (CMS) released the CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule, outlining updates to Medicare facility payment policies and rates for hospital outpatient and ASC services.

Here are the top takeaways:

• A 2.6% facility payment increase for ASCs and hospital outpatient departments for those meeting quality reporting requirements.
• CMS added more than 500 procedures that can be performed in ASCs, including codes for POEM (CPT 43497) and EndoFLIP (CPT 91040). CMS also finalized criteria for adding procedures to the ASC Covered Procedures List (ASC CPL), which could open the door for the inclusion of more GI procedures and tests.
• Payment for drug administration services provided in off-campus provider-based departments that were exempt from site-neutral payment policies will be reduced, effective Jan. 1, 2026, to the physician fee schedule equivalent rate. This change will impact GI drugs delivered by infusion.
• CMS removed five measures from reporting to the Hospital Outpatient (OQR) and ASC quality reporting programs and extended voluntary reporting for "Excessive Radiation" under the OQR, which was expected to be mandatory in 2027.

In case you missed it: On Oct. 31, CMS released the final payment rates for physician services, where despite a one-time conversion factor increase for most physicians, GI practices and patients will be significantly impacted by practice expense changes and misguided ‘efficiency’ adjustments. Click here for the Tri-Society summary.

Resources

2026 OPPSASC Payment System Final Rule
2026 OPPS/ASC Payment System Final Rule Press Release
2026 OPPS/ASC Payment System Final Rule Fact Sheet
2026 Hospital Outpatient Final Payment Changes
2026 Hospital Outpatient Top GI Code Final Payment Changes
2026 ASC Final Payment Changes
2026 ASC Top GI Code Final Payment Changes