CMS Releases Concerning Final OPPS and ASC Rulings, and Issues Telehealth Updates

The Centers for Medicare and Medicaid released the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule on Nov. 21, increasing rates by 2.6%, among other updates. Failing to keep pace with rising costs and the ongoing financial pressure facing providers, this increase is causing concern as the healthcare system in the United States is already struggling with inflation, workforce retention and uncompensated care, all of which threaten the stability of outpatient and patient access.

Without a more meaningful increase to reflect the rising operational costs, the ability of providers to maintain current levels of service, invest in works and support patient access may be in jeopardy.

WellLink has expressed concern about the delay in releasing the OPPS final rule, citing the compressed timelines as a major implementation challenge. The resulting system adjustments and updates to billing and budget processes, as well as staff training, are challenges for providers seeking to focus on delivering high-quality care for patients.

Some of the key Provisions of the Final Rule:

ASC Covered Procedure List (CPL)

CMS is revising review criteria currently in place for the ASC CPL to allow 276 proposed procedures. CMS also added 271 codes that it removed concurrently from the inpatient-only (IPO) list for calendar year 2026. And CMS finalized the addition of 13 additional procedures submitted during the comment period.  

Eliminating the Inpatient Only list

CMS is finalizing its proposal to phase out the IPO list over a three-year period, beginning with the removal of 285 mostly musculoskeletal procedures for calendar year 2026. This policy allows for these services to be paid by Medicare in the hospital outpatient setting when determined to be clinically appropriate, giving physicians greater flexibility in determining the most appropriate site of service.

Skin Substitutes

The way CMS pays for skin substitutes will change as the agency will unpackage skin substitutes and reimburse them under a single flat “incident-to” supply rate. This replaces the previous model where products are reimbursed at their own unique rate.

Hospital Survey on Drug Acquisition Costs

CMS will conduct a survey of OPPS hospitals to collect data on drug acquisition costs for specific covered outpatient drugs (SCOD), and for drugs and biologicals CMS historically treats as SCODs.

Direct Supervision

A revised definition of direct supervision was permanently adopted, allowing “immediate availability” of a supervising practitioner using audio/video real-time communications technology (excluding audio-only) for all services described as incident-to a physician’s professional services, except for select global surgery codes.

Read more of the final rule updates by visiting cms.gov.

CMS Issues Updates on Telehealth and Medicare Claims Processing

When Congress passed a continuing resolution to fund the federal government in November, telehealth access was extended through Jan. 30, 2026. In response, CMS finalized new telehealth policies, released updated telehealth frequently asked questions (FAQ), and provided an update on processing Medicare claims impacted during the government shutdown.

Telehealth Extensions

Through Jan. 30, 2026, patients can receive telehealth services from any location without needing to be in a rural area or medical facility. After Jan. 30, 2026, beneficiaries will generally need to be in a medical facility and in a rural area to receive Medicare telehealth service, with the exception of behavioral health services.

Starting Jan. 31, 2026, physical therapists, occupational therapists, speech-language pathologists, and audiologists can no longer provide Medicare Telehealth services. Hospitals currently can bill for outpatient therapy, diabetes self-management training and medical nutrition therapy when delivered remotely to patients. This ends on Jan. 31, 2026.

Addressing the government shutdown and claims that were filed during that period of time, the updates confirm CMS will continue to pay telehealth claims in the same way they had been paid before Oct. 1, 2025. Flexibilities will apply retroactively as if there had not been a lapse in the application of telehealth flexibilities, through Jan. 30. 2026.

As policymakers grapple with the growing patient demand for telehealth services, momentum continues around the possibility of extending telehealth beyond the current deadlines. On Sept. 2, 2025, U.S. Representatives Earl Carter and Debbie Dingell introduced the Telehealth Modernization Act of 2025 (H.R. 5081). The bill seeks to extend telehealth flexibilities through fiscal year 2027.

Provider Advocacy

This week, WellLink’s Jodi Mitchell, senior director of government relations & policy, and Daniel Lettenberger-Klein, executive director of member programming, visited lawmakers on Capitol Hill to advocate for a number of issues impacting provides, including sustainable affordable healthcare. Their key messages included requests to:

• Extend the enhanced premium tax credits.
• Maintain the health extenders that were included in the most recent Continuing Resolution and expire Jan. 30, 2026.
• Protect the 340B Drug Pricing Program.
• Reject site neutral payment cuts.
• Restore funding for critical regional hospital and healthcare emergency preparedness activities.
• Support bills that enhance access to naloxone and non-opioid pain management options.
• Support the Prompt and Fair Pay Act (H.R. 4559).
• Support legislation that would strengthen the medical supply chain.
• Support bills that support the healthcare workforce.

For more on WellLink Health Alliance’s advocacy work, view our website.