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The Centers for Medicare and Medicaid Services (CMS) has finalized a rule that will expand outpatient surgery options and lower out-of-pocket costs for imaging services and certain prescription drugs for people with Medicare, the agency announced on November 4.
The calendar year 2027 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center final rule updates 2027 payment rates for hospital outpatient departments and ambulatory surgical centers, and changes how Medicare pays for drugs purchased under the 340B Drug Pricing Program, which lets hospitals serving low-income patients buy outpatient drugs at discounted prices.
By aligning payments more closely with what hospitals actually pay to acquire those drugs, CMS estimates the change will save people with Original Medicare an estimated $1.1 billion in drug costs in 2027 and save taxpayers an additional $4.35 billion, reducing total drug spending by approximately $5.45 billion in 2027 alone. Beneficiaries who receive a qualifying drug in a hospital outpatient department are expected to save an average of $900 in drug costs in calendar year 2027.
The rule also extends site-neutral payment to imaging services without contrast performed at off-campus provider-based departments, paying the lower Physician Fee Schedule equivalent rate instead of the outpatient hospital rate. The services include certain bone density scans, x-rays, ultrasounds, CT scans and MRIs. CMS estimates that change will save beneficiaries and taxpayers a total of $260 million in calendar year 2027 and more than $9 billion from calendar year 2027 through 2036.
CMS Administrator Dr. Mehmet Oz said: "CMS is committed to spending taxpayer funds wisely and efficiently, so America's seniors can continue getting the care they need. By right-sizing payments and rooting out waste, today's reforms will drive affordability in Medicare for current beneficiaries while ensuring it will still be there to serve their children and grandchildren."
The rule also continues to phase out the "Inpatient Only" procedure list, allowing more services to be delivered in outpatient settings, and expands the ambulatory surgical center covered procedures list by several hundred surgical procedures.