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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: