CMS Proposes 2027 Updates for Outpatient Hospital Department Services

July 31, 2026

The Centers for Medicare & Medicaid Services (CMS) is proposing changes [PDF] to payments for services provided by outpatient hospital departments for 2027. Under the proposal, Medicare payments to the 3,500 hospitals paid under the outpatient prospective payment system (OPPS) would increase by 2.4% in 2027-$9.5 billion more than OPPS providers received in 2026. As a result, the sector should see Medicare payments of approximately $110.9 billion next year.

What This Means for Audiologists and Speech-Language Pathologists

This proposed rule primarily impacts audiologists because their services are paid under the OPPS. Most speech-language pathology services provided in this setting are exempt from the OPPS and paid under the Medicare 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.

CMS has made positive payment updates to the APCs that include audiology services. It also added four new vestibular assessment codes to APC 5721.

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 (OQR) Program

CMS proposes to update the validation process it uses to ensure appropriate reporting of measures to the Hospital OQR. Specifically, it would include both chart-abstracted and electronic clinical quality measures (eCQMs) beginning with the CY 2027 reporting period that determines CY2030 payment. This would delay required use of Fast Healthcare Interoperability Resources (FHIR)-based digital quality measure (dQM) reporting. CMS will develop a 2-year transition period for FHIR-based dQMs, after which they will become mandatory.  CMS has also issued a request for information on a potential advance care planning measure for the hospital outpatient department setting.

ASHA will support CMS' interest in meaningful outpatient quality measurement while urging CMS to include communication, hearing, cognition, swallowing, nutrition, hydration, caregiver training, and comprehensive functional outcomes as core components of patient-centered outpatient care. ASHA will also highlight the importance of communication access in valid and meaningful advance care planning.

Prior Authorization for Botulinum Toxin Injection Services

CMS proposes to add botulinum toxin injection services to the hospital outpatient prior authorization process for dates of service on or after July 1, 2027. Although this proposal is not primarily an SLP payment issue, it may affect patients treated by SLPs, including individuals with voice disorders, neurological disorders, dysphagia, sialorrhea, and spasticity.

ASHA will urge CMS to ensure that prior authorization does not delay or prevent medically necessary botulinum toxin treatment for patients with voice, swallowing, neurologic, airway, secretion-management, or communication-related conditions.

Resources

For more information, see CMS' press release on the proposed rule.

Questions?

Email [email protected].