CMS Finalizes 2026 Rule to Strengthen Hospital Price Transparency Nationwide
Key Clinical Summary
- The Centers for Medicare & Medicaid Services (CMS) finalized new 2026 rules to standardize and improve hospital price transparency.
- Hospitals must disclose median, 10th, and 90th percentile allowed amounts based on actual remittance data.
- Enforcement begins April 1, 2026, following a 3-month grace period for compliance.
In line with President Biden’s Executive Order 14221, CMS has issued a final rule under the 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Final Rule (CMS-1834-FC). The regulation advances national hospital price transparency by requiring hospitals to publish actual, comparable dollar amounts for medical services and ensure data accuracy through standardized reporting.
The final rule replaces estimated payer-specific charges with verified, quantifiable “allowed amounts” to make hospital pricing data more meaningful and comparable across institutions. Hospitals will now be required to post the median, 10th, and 90th percentile allowed amounts for services in their machine-readable files (MRFs), as well as the count of allowed amounts used in each calculation.
To calculate these figures, hospitals must rely on electronic data interchange 835, electronic remittance advice, or equivalent remittance sources. When calculated percentiles fall between 2 data points, CMS instructs hospitals to use the next highest observed value. Each MRF must reflect data from a 12- to 15-month lookback period.
Additionally, CMS is mandating an attestation statement affirming that all standard charge data are true, accurate, and complete. The statement must identify the hospital’s chief executive officer, president, or a designated senior official responsible for overseeing data accuracy.
Hospitals must also include their Type 2 National Provider Identifier (NPI) numbers in the MRFs to facilitate standardized comparisons across hospitals and health systems.
CMS is revising its civil monetary penalty framework to incentivize compliance. Hospitals that waive their right to a hearing and promptly pay assessed penalties will receive a 35% reduction, except in cases involving core transparency violations—such as failure to publish an MRF or shoppable services data.
Clinical Implications
These updates are intended to make hospital pricing data more actionable for patients, payers, and policymakers. By replacing estimated charges with verified payment data, CMS seeks to eliminate ambiguity and enable true cost comparisons across hospitals and geographic regions.
The inclusion of percentile ranges and NPIs enhances data granularity and interoperability, improving the accuracy of payer analytics, benchmarking, and value-based purchasing decisions. For managed care organizations and payer networks, this rule offers a clearer view of pricing variation and contract efficiency.
Hospitals will have until January 1, 2026, to implement the new requirements, with enforcement delayed until April 1, 2026, giving institutions time to adjust systems and validate data quality.
Conclusion
Effective January 1, 2026, the new CMS price transparency rule marks a major step toward standardized, verifiable hospital pricing nationwide. The provisions aim to enhance consumer trust, streamline payer negotiations, and foster a more transparent and accountable health care marketplace.
Reference
Centers for Medicare & Medicaid Services. CY 2026 OPPS and Ambulatory Surgical Center Final Rule - hospital price transparency policy changes. November 21, 2025. Accessed November 24, 2025. https://www.cms.gov/newsroom/fact-sheets/cy-2026-opps-ambulatory-surgical-center-final-rule-hospital-price-transparency-policy-changes
