CMS updates hospital price transparency guidelines

Editor's Note

The Centers for Medicare & Medicaid Services (CMS) has updated hospital price transparency guidelines to require publishing real, calculated dollar amounts rather than placeholders and estimates.

As detailed in the agency’s May 22 announcement, the revision complies with President Trump’s February 25 Executive Order 14221, “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information.”

The new guidance prohibits hospitals from using placeholder values like “999999999” in machine-readable files and instead mandates real, average dollar amounts for each payer-specific negotiated charge, including estimates when a full payment history is not available. CMS emphasized that this data must be based on actual historical electronic remittance advice transactions from the past 12 months.

According to the announcement, this move is rooted in earlier rulemaking, including the CY 2024 Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) final rule, which already required hospitals to display charges in dollar amounts where calculable. Now, CMS is tightening enforcement, making clear that estimated allowed amounts must be derived from actual reimbursement data whenever possible. Hospitals that negotiate payments based on case rates, fee schedules, or per diems must calculate and encode those values explicitly.

More detail is available in the full announcement, and the agency is seeking public input on the change through July 21.