The Centers for Medicare & Medicaid Services released the proposed Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule for calendar year 2027, introducing broad payment adjustments, policy shifts for urological devices, and an expansion of prior authorization requirements across traditional Medicare. This proposed adjustment stems from an inpatient hospital market basket increase of 3.2% for inpatient services paid under the inpatient prospective payment system, which is then offset by a productivity adjustment of 0.8%.
### Projected Payment Totals and Adjustments
Total Medicare payments to Outpatient Prospective Payment System providers, which include Medicare beneficiary cost sharing, are projected to reach $110.9 billion in 2027. Payment rates within ambulatory surgical centers will likewise increase by 2.4%, bringing total projected payments for that setting to approximately $9.9 billion. Facilities that fail to meet established quality reporting requirements will face a 2% reduction in overall Medicare payments. Meanwhile, hospitals captured under the 340B remedy offset will see a separate 3% reduction.
### Permanent Prostatic Urethral Stent Reassignment
Federal regulators propose a substantial payment increase for a specific urological procedure involving permanent prostatic urethral stents. According to the proposed rule, the Centers for Medicare & Medicaid Services will reassign CPT code 52282, which covers cystourethroscopy with the insertion of a permanent urethral stent, from ambulatory payment classification 5374 to ambulatory payment classification 5375. This shift changes the calendar year 2027 payment rate from $4,064 to $6,292, effectively increasing outpatient hospital department payments for the procedure by 55%. To evaluate these payment levels, the agency analyzed Medicare outpatient claims for code 52282 furnished between January 1, 2025, and December 31, 2025. While the analysis of 109 claims yielded a geometric mean cost of approximately $4,005, federal officials determined that prior claims data did not accurately reflect current costs because no Food and Drug Administration-approved permanent prostatic urethral stent had been available in the United States for approximately nine years. Following the premarket approval of the ProVee System in late 2025, the agency adjusted its payment classification to match current clinical resource costs.
### Policy Changes and Public Comment Timeline
Beyond direct rate updates, the proposed rule continues the agency’s ongoing policy to phase out the inpatient-only list and expands prior authorization protocols within traditional Medicare. The proposal also reduces payments for drugs acquired under the 340B drug pricing program. The Centers for Medicare & Medicaid Services has published the proposed rule alongside an accompanying fact sheet and rate-setting addenda. Public comments on the regulatory proposals are open and must be submitted to the agency by August 31.
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