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2026-07-02 - CY 2027 Hospital Outpatient Prospective Payment System & Ambulatory Surgical Center Proposed Rule
Effective date
Not stated in the notice
Identified
Jul 3, 2026
Summary
CMS issued a proposed rule for CY 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment updates, including revised payment rates, expanded volume control methods, reduced 340B drug payments, elimination of the inpatient-only list, and new prior authorization requirements for botulinum toxin injection codes. This is a proposed rule requiring comment period completion before final implementation.
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What to do
Action · 7 steps
01REQUIREMENTS: This is a PROPOSED rule (not yet final).
02By the comment deadline (typically 60 days from Federal Register publication): 1) Billing team should monitor CMS Federal Register for final rule publication and effective date announcement.
032) Once finalized, update billing software for any new OPPS/ASC payment rates and ASC quality reporting requirements.
043) Implement prior authorization workflow for botulinum toxin injection codes when final rule specifies which codes require prior auth.
054) For codes E0747, E0748, E0760 (non-invasive bone growth stimulators): Claims with dates of service on or after May 18, 2026, MUST be billed with KF modifier—verify billing system applies KF modifier retroactively if needed.
065) Prepare for potential elimination of inpatient-only list by reviewing current inpatient-only procedures that may shift to outpatient billing.
076) Track final rule details on hospital price transparency encoding requirements and ASC/hospital quality reporting program changes.
If missed: Failure to implement prior authorization when required will result in claim denials; failure to apply KF modifier to bone growth stimulator codes will cause claim rejections.
Codes mentioned
E0747E0748E0760
Original notice
2026-07-02 - CY 2027 Hospital Outpatient Prospective Payment System & Ambulatory Surgical Center Proposed Rule
cms.gov · Always check the source before changing claims.
Related changes
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