CMS Proposes Site-Neutral Payments for Select Imaging Services in 2027

The Centers for Medicare & Medicaid Services released a proposed 2027 outpatient payment rule on July 2 that would expand site-neutral payments to imaging services without contrast performed at certain off-campus hospital outpatient departments. Newsweek reported that the services affected include X-rays, CT scans and MRIs.

Under the proposal, Medicare would pay those services at the physician fee schedule rate rather than the higher hospital outpatient rate.

Rural Sole Community Hospitals would remain exempt. The policy would extend an existing site-neutral rule that already covers some clinic visits and drug-administration services at the same facilities. CMS estimates the change would reduce beneficiary cost-sharing obligations by approximately $70 million in 2027, lower overall Medicare spending by roughly $260 million, produce about $190 million in Part B savings and cut beneficiary premiums by about $70 million.

The agency stated the measure is intended to prevent beneficiaries from facing higher premiums and cost-sharing based solely on the site of care. Alex Beene, a financial literacy instructor at the University of Tennessee at Martin, told Newsweek that the decision means Medicare is declaring the same service should not cost dramatically more simply because it occurs inside a hospital-owned outpatient department instead of a traditional doctor’s office.

Kevin Thompson, CEO of 9i Capital Group, said the proposal comes down to competition, noting that hospitals have grown larger by acquiring independent physician practices.

Michael Ryan, founder of MichaelRyanMoney.com, stated that a beneficiary could see a lower bill for imaging and that repeated use could produce hundreds of dollars in savings over time. CMS will collect public comments on the proposed rule before issuing a final version. If finalized, the imaging changes would take effect in 2027.