To amend title XVIII of the Social Security Act to align payment under Medicare for specified surgical procedures with high-cost supplies furnished in office-based facilities, and for other purposes.
- Bill Number
- H.R. 7863
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Status
- Introduced
- Latest Action
- 2026-03-09: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-03-18T08:06:45Z
AI-Generated Summary
Purpose of the legislation This bill amends title XVIII of the Social Security Act to create a new Medicare payment category for certain high-cost surgical procedures performed in physician offices. It aims to align payments for facility services in these settings with those in ambulatory surgical centers, starting in 2027.
Key provisions outlined
- Coverage expansion: Adds facility services for "specified high supply cost surgical procedures" furnished in office-based facilities to Medicare Part B coverage under section 1832(a)(2)(F).
- Payment methodology: Pays office-based facilities 90 percent of the ambulatory surgical center facility fee for these procedures, with a special calculation for device-intensive procedures that sets the non-device portion at 90 percent of the standard amount.
- Copayment protection: Limits patient coinsurance for these facility services to the annual inpatient hospital deductible; Medicare increases provider payment to cover any excess.
- Definition of covered procedures: Includes surgical procedures payable in ambulatory surgical centers as of 2023 that, when performed in a physician office, involved a supply item priced above $500 (with rules for multiple identical items). The list is reviewed annually beginning in 2028, with mandatory additions or permissive removals based on updated cost thresholds adjusted by the Medicare Economic Index.
- Office-based facility requirements: Defines these as physician offices that meet health and safety standards, accept Medicare assignment, and agree to participate as office-based facilities for the covered procedures.
- Conforming changes: Adjusts payment rules for ambulatory surgical centers and off-campus hospital outpatient departments to treat these procedures consistently; updates provider agreement, state survey, and enrollment provisions to include office-based facilities.
Significant changes to existing law introduced
- Creates a new subsection 1834(bb) that establishes site-specific payment for office-based facilities, previously limited to physician fee schedule practice expense payments or ambulatory surgical center rates.
- Introduces a new provider type under section 1866(e) for office-based facilities limited to these procedures.
- Modifies copayment rules to cap liability at the inpatient deductible rather than applying standard Part B coinsurance.
Potential impacts on government agencies, citizens, or international relations
- Government agencies: Requires the Centers for Medicare & Medicaid Services to develop new payment systems, conduct annual reviews, update regulations, and oversee enrollment and compliance for office-based facilities.
- Citizens: Medicare beneficiaries may face lower out-of-pocket costs due to the copayment cap and could gain access to more procedures in convenient office settings.
- International relations: No direct effects identified.
Identify the main stakeholders affected by this legislation
- Physicians and their office-based practices performing the specified procedures.
- Medicare beneficiaries receiving these services.
- The Centers for Medicare & Medicaid Services and state survey agencies responsible for oversight.
- Ambulatory surgical centers and hospitals, which may face competitive or payment adjustments.
- Medical device manufacturers supplying high-cost items used in the procedures.
Highlight any notable legal, constitutional, or political implications The bill expands Medicare payment authority within existing statutory frameworks without altering core constitutional structures. It addresses payment site differentials through administrative rulemaking and annual adjustments, potentially affecting the balance between office-based and facility-based care delivery.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Bilirakis, Gus M. [R-FL-12]
Cosponsors (4)
Rep. Ruiz, Raul [D-CA-25], Rep. Murphy, Gregory F. [R-NC-3], Rep. Davis, Danny K. [D-IL-7], Rep. Joyce, John [R-PA-13]
Recent Actions
- 2026-03-09: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-03-09: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-03-09: Introduced in House
- 2026-03-09: Introduced in House
Bill Versions
- Promoting Fairness for Medicare Providers Act of 2026 — issued 2026-03-09 — PDF (15 pages)