Congress recently enacted the Consolidated Appropriations Act of 2026, which includes new Medicare conditions of payment for off-campus hospital outpatient departments. Beginning January 1, 2028, Medicare payments will not be made for items and services furnished by an off-campus department unless the hospital satisfies new requirements related to location-specific National Provider Identifiers (“NPIs”) and provider-based attestations.
The new statutory requirement applies to all off-campus outpatient departments of hospitals that are paid under the Outpatient Prospective Payment System, including excepted or grandfathered departments. We believe that these requirements are aimed at increasing compliance with the provider-based rules and providing the Centers for Medicare & Medicaid Services (“CMS”) with more data related to services furnished at these off-campus locations.
Background
Medicare covers and pays for services provided at off-campus hospital locations as hospital outpatient services (although some services are subject to site-neutral payments), if the location/facility satisfies the provider-based requirements under 42 C.F.R. § 413.65. These requirements address several factors, including licensure, financial and clinical integration, public awareness and operational control.
Historically, submitting provider-based attestations has been voluntary for most hospitals. Further, CMS has not required off-campus provider-based locations to apply for and use a separate NPI, allowing the off-campus locations to use the main hospital’s NPI.
Changes to NPI and Provider-Based Attestations
Section 6225 amends Section 1833(t) of the Social Security Act to prohibit Medicare payment for services furnished on or after January 1, 2028, unless the following conditions are met:
- Unique NPIs. The off-campus outpatient department must obtain and bill under an NPI that is separate from the hospital’s main NPI.
- Provider-based Attestation. The hospital must submit an initial attestation confirming compliance with 42 C.F.R. § 413.65 within the two years preceding the date services are furnished.
- Regular Attestation Updates. After the initial attestation submission, hospitals must submit subsequent attestations at intervals to be established by CMS through forthcoming rulemaking.
These changes remove prior flexibility. Hospitals that do not satisfy these requirements risk claim denials or payment delays, reclassification of services, recoupment following audit and operational disruption at off-campus sites.
What Can Hospitals Do Now?
While hospitals wait for further direction from CMS, there are steps they can take now to prepare for these changes. Early coordination is important because compliance will require participation from enrollment, billing, compliance, IT and operations teams, and early planning can reduce implementation risk. Until CMS establishes a new submission process, hospitals may continue using existing attestation procedures.
- Create an inventory list of all off- campus provider-based locations. Relevant information includes the hospital to which it is provider-based, services provided at the location, NPIs that are used and whether an attestation was submitted by CMS.
- Assess each location’s provider-based compliance. Review compliance now to prevent billing disruptions and reduce implementation challenges later. This assessment should include, but not be limited to, review of signage, websites and patient communications to ensure locations are held out to the public as hospital departments.
- Consider submitting attestations now for select locations.
- Begin planning for separate NPIs now where required. Implementing location-specific NPIs may require updates to enrollment records, billing systems and payer contracts. Starting early can help prevent billing disruptions and payment delays as the 2028 deadline approaches.
Looking Ahead
CMS rulemaking is expected to provide additional detail on submission procedures, review protocols and attestation timing. The guidance may also address whether certain services furnished at off-campus locations fall outside the statutory requirement where no site-of-service payment differential exists. Hospitals should monitor rulemaking for updates.
Hospitals that begin preparing now will be better positioned to maintain uninterrupted Medicare reimbursement and avoid last-minute operational challenges.
If you have questions regarding off-campus department compliance or NPI enrollment strategy, please contact:
- Benjamin Fee at (720) 282-2030 or bfee@hallrender.com;
- Lauren Hulls at (317) 977-1467 or lhulls@hallrender.com;
- Brian Jent at (317) 977-1402 or bjent@hallrender.com;
- Joseph Krause at (414) 721-0906 or jkrause@hallrender.com;
- Regan Tankersley at (317) 977-1445 or rtankersley@hallrender.com;
- Lori Wink at (414) 721-0456 or lwink@hallrender.com;
- Julie Mitchell at (317) 429-3643 or jmitchell@hallrender.com;
- Raminta Kizyte at (303) 557-2112 or rkizyte@hallrender.com; or
- Your primary Hall Render contact.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.
