Promoting Fairness for Medicare Providers Act of 2026

This legislation, known as the Promoting Fairness for Medicare Providers Act of 2026 , seeks to modify Medicare payment rules for specific surgical procedures. Its primary goal is to align the payment for certain procedures involving high-cost supplies when performed in office-based facilities , making them comparable to payments for services delivered in ambulatory surgical centers (ASCs). Starting in 2027, facility services for these procedures will be paid at 90 percent of the amount an ASC would receive. A "specified high supply cost surgical procedure" is defined as one that, as of 2023, was payable in an ASC and a physician's office, and included a supply item with a price input over $500 for practice expense. The Secretary of Health and Human Services is mandated to annually review and revise this list, adding procedures that meet updated criteria and potentially removing those that no longer qualify. For device-intensive procedures , a special payment calculation is applied, adjusting the non-device portion. Furthermore, patient coinsurance for facility services in these office-based settings is capped at the inpatient hospital deductible, with Medicare increasing payments to providers to cover any difference. An "office-based facility" must meet specified health and safety standards and agree to Medicare's terms, including accepting the determined payment as full compensation.