CMS Proposes 2026 Updates for Outpatient Hospital Department Services

July 30, 2025

The Centers for Medicare & Medicaid Services (CMS) is proposing changes [PDF] to payments for services provided by outpatient hospital departments for 2026. Under the proposal, Medicare payments to this sector would increase by 2.4%, which amounts to $8.1 billion more in total spending compared to 2025, for a total of $100 billion.

What This Means for Audiologists and SLPs

This proposed rule primarily impacts audiologists because their services are paid under the Outpatient Prospective Payment System (OPPS). Whereas, most speech-language pathology services provided in this setting are exempt from the OPPS and paid under the physician fee schedule.

Changes to Audiology Payment Classifications

Each year, ASHA analyzes the ambulatory payment classifications (APCs) to determine if audiology services are appropriately categorized and valued. APC modifications are done when services no longer meet criteria or cost similarity.

In reviewing this proposed rule, CMS has made APC group modifications for a few audiology-related procedures. ASHA is analyzing to determine whether these procedures are appropriately assigned to the modified APC groups.

ASHA also noted that CMS is proposing both increases and decreases to payment rates in different APC groups. Some audiology procedures could see a cut as large as $148.64. CMS states these adjustments are based on recent claims and cost report data analysis, as well as updates in medical practice and technology.

ASHA is reviewing these payment and APC grouping changes and may submit comments to CMS to ensure audiology services are appropriately categorized and valued.

Hospital Outpatient Quality Reporting Program Updates

The Hospital Outpatient Quality Reporting (OQR) Program is a pay-for-reporting program that requires hospital outpatient departments (HOPDs) to report data on certain quality measures specified by CMS. If they don’t, Medicare payments are reduced by 2-percentage points. CMS makes this data available to the public on its Care Compare website for patients and their caregivers to review.

CMS Proposes to Remove Some Measures

CMS is planning to stop requiring hospitals to report on the following measures:

COVID–19 Vaccination Coverage Among Healthcare Personnel (HCP) (beginning with the CY 2024 reporting period/CY 2026 payment determination).
Hospital Commitment to Health Equity (HCHE) (beginning with the CY 2025 reporting period/CY 2027 payment determination).
Screening for Social Drivers of Health (SDOH) (beginning with the CY 2025 reporting period).
Screen Positive Rate for SDOH (beginning with the CY 2025 reporting period).

These changes mirror Medicare’s proposals for other post-acute care settings. Addressing upstream factors to decrease costs and improve outcomes is very much in keeping with the prevention and wellness model put forth by the administration. Therefore, ASHA remains committed to ensuring that all factors that impact cost, outcomes, and overall value of care—including SDOH—remain as the payment system transitions from volume-based care to value-based care.

Looking Ahead: New Quality Measures Being Considered

CMS is seeking input on future quality measures related to well-being and nutrition in the Hospital OQR, Rural Emergency Hospital Quality Reporting (REHQR), and Ambulatory Surgical Center Quality Reporting (ASCQR) Programs. ASHA is preparing a response to this request for information.