Promoting Fairness for Medicare Providers Act of 2026

Key Points

• This bipartisan bill changes how Medicare pays for surgeries done in a doctor's office that require expensive supplies costing more than $500. Starting in 2027, qualifying doctor's offices would receive 90% of the payment that ambulatory surgical centers get for the same procedures, helping cover the high cost of specialized implants and tools.
• To receive these higher payments, a doctor's office must become a certified "office-based facility" that meets health and safety standards, accepts Medicare's payment as the full amount, and agrees to accept assignment for all covered procedures — meaning no surprise bills for patients.
• The bill caps what patients pay out of pocket for these office-based surgeries. A patient's coinsurance cannot exceed the standard Medicare inpatient hospital deductible for that year, protecting seniors from unexpectedly large bills.
• When a patient's coinsurance is capped, the doctor's office doesn't lose out — Medicare picks up the difference, ensuring providers are still paid the full amount for the procedure.
• Starting in 2028, the Secretary must review and update which procedures qualify each year. New procedures can be added if they meet the cost threshold, and procedures may be removed if their supply costs fall below 80% of that threshold, keeping the list current with medical technology changes.

Votes

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Related Bills

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