On November 21, 2025, CMS released the CY26 OPPS Final Rule and—importantly—most of the major proposals relating to hospital price transparency (our summary and comment here) have been adopted as final requirements. Hospitals should be aware that the compliance and reporting obligations discussed throughout the rule-making process are now moving forward, with only minor modifications. This summary highlights the key changes, and includes our firm’s perspective on what’s most important, what may be challenging, and what to watch for as implementation begins.

1. Four New Data Elements for the Machine Readable File

Starting January 1, 2026, hospitals will need to include four new data elements in their machine-readable files (MRFs) whenever payer-specific negotiated charges are based on a percentage or algorithm:

• Median allowed amount
• 10th percentile allowed amount
• 90th percentile allowed amount
• Count of allowed amounts (the number of claims used to calculate the above)

The previous “estimated allowed amount” requirement is removed as these new elements are now the focus.  CMS will require that these figures be calculated using data from a lookback period of at least 12 months and up to 15 months before posting the MRF. In addition, if the calculated percentile falls between two observed values, hospitals must use the next highest value so that the reported value in the MRF represents an observed claim amount.

Two important privacy notes were provided in the rule:

• For low-volume services (where the count is 1–10), hospitals should encode the count as “1 through 10” to protect patient privacy.
• If there are zero claims, hospitals should encode “0” and leave the allowed amounts blank, with an explanation in the notes.

2. Standardization of Data Sources

CMS requires that hospitals use EDI 835 ERA transaction data (or an equivalent source) to calculate and encode allowed amounts. This is intended to ensure consistency and comparability across hospitals nationwide.

3. Significant Attestation Statement Changes

Hospitals must now attest in their MRFs that: “To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of § 180.50, and the information encoded is true, accurate, and complete as of the date in the file. The hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.”

In addition to affirming the statement above, the name of the CEO, president, or senior official responsible for the data must be included in the MRF, reinforcing executive accountability.

We expressed significant concern about the implications of the attestation statement in our comments to CMS. The statement requires hospitals to confirm that all necessary information is included in the MRF so the public can derive actual dollar amounts for payer-specific negotiated charges. In reality, hospital-payer contracts often involve complex logic—such as detailed grouping and policy definitions, exclusions, carveouts, and hierarchy rankings—that are difficult to fully capture in a machine-readable file. While CMS’s examples in the rule are helpful, they do not address these intricacies. This may reflect CMS’s understanding, as previously described in the CY24 OPPS Final Rule, that encoding such detail would be “unwieldy and burdensome.” In the current final rule, CMS emphasizes the need for “anchor” points, which aligns with the simplified examples provided. Until further guidance is released, hospitals should focus on clear, comprehensive descriptions within the limits of their systems and contracts, and monitor for additional CMS instructions to help bridge the gap between regulatory expectations and real-world complexity.

4. Reporting National Provider Identifier (NPI)

Hospitals must report their Type 2 NPI(s) (organizational NPIs) in the MRF, specifically those associated with taxonomy codes for hospitals or hospital units. This helps align hospital data with other healthcare datasets such as the Transparency in Coverage (TiC) files and supports cross-comparison.

5. Civil Monetary Penalties (CMPs)

CMS has not finalized any new conditions under which CMPs would be imposed, however, there is a new provision for non-compliant hospitals that waive their right to an administrative law judge (ALJ) hearing within 30 days to receive a 35% reduction in the penalty amount. However, this reduction does not apply to subsequent penalties for ongoing violations or for core noncompliance (such as failing to post an MRF).

6. Effective Dates and Enforcement

While all new requirements take effect January 1, 2026, CMS will delay enforcement until April 1, 2026, giving hospitals a three-month window to get systems and processes in place.

7. Technical Guidance

CMS mentions that it will provide further instructions and examples for encoding these new data elements in the CMS Hospital Price Transparency Data Dictionary GitHub Repository and on the CMS website.

Conclusion

The CY26 OPPS Final Rule brings important updates to hospital price transparency, with most proposals now finalized and moving toward enforcement. While many requirements are clear and actionable, the new attestation statement stands out as a key area for ongoing attention. Hospitals should focus on providing thorough and accurate descriptions within the limits of their systems and contracts, and closely monitor for additional CMS guidance—especially as it relates to the practical complexities of real-world contract logic. Our firm will continue to track developments closely to ensure hospitals, their teams, and their patients receive the best possible guidance as these changes take effect.