What the 2026 CMS Hospital Price Transparency Rule Requires

What the rule requires hospitals to post

Most licensed U.S. hospitals must post their standard charges on a public website in two ways. First, a single machine-readable file with gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges for all items and services. Second, a consumer-friendly display of at least 300 shoppable services (or as many as the hospital provides if fewer than 300), either as a file or an internet price estimator tool. Source: CMS Hospital Price Transparency, Hospitals page.

What changed on January 1, 2026

CMS finalized the changes in the CY 2026 OPPS and ASC final rule (CMS-1834-FC) on November 21, 2025, citing Executive Order 14221. The MRF changes at 45 CFR 180.50 are:

• Allowed amounts in dollars. The estimated allowed amount is removed. When a payer-specific negotiated charge is based on a percentage or algorithm, the hospital must encode the median, 10th percentile and 90th percentile allowed amounts in dollars, plus the count of allowed amounts used to calculate them.
• Remittance data. Hospitals must use EDI 835 electronic remittance advice, or an equivalent source, with a lookback of at least 12 and no more than 15 months before posting. If a percentile falls between two observed amounts, use the next highest observed value.
• Attestation. The affirmation statement is replaced by an attestation that the file includes all applicable standard charge information, that it is true, accurate and complete as of the date in the file, and that, where a charge cannot be expressed as a dollar amount, the hospital has given the information needed to derive one. The hospital must also encode the name of the CEO, president or senior official designated to oversee the data.
• Type 2 NPIs. Hospitals must report each active organizational (Type 2) NPI tied to a primary taxonomy code starting with 28 (hospital) or 27 (hospital unit).

Source: CMS fact sheet on the CY 2026 OPPS/ASC final rule; the rule itself is in the Federal Register.

Dates that matter

• November 21, 2025: CMS finalizes the rule.
• January 1, 2026: new MRF requirements and the penalty reduction take effect.
• April 1, 2026: CMS begins enforcing the new 45 CFR 180.50 MRF requirements (a three-month enforcement delay).

Penalties

Under 45 CFR 180.90, the maximum daily civil monetary penalty is $300 for hospitals with 30 beds or fewer, the number of beds times $10 for hospitals with 31 to 550 beds, and $5,500 for hospitals with more than 550 beds. CMS adjusts these amounts annually for inflation. A hospital that waives its right to an ALJ hearing within 30 days of the notice of imposition gets a 35 percent reduction, except where the penalty is for failing to post an MRF or the consumer-friendly display at all. Source: 45 CFR 180.90.

Frequently asked questions

Did CMS change who has to comply?

The sources above describe changes to what the file must contain and how penalties work. They do not change which hospitals are covered; that is defined at 45 CFR 180.20 and 180.30.

Do hospitals still need to post shoppable services?

Yes. The consumer-friendly display of shoppable services under 45 CFR 180.60 is a separate requirement from the MRF.

When did enforcement of the new MRF elements start?

CMS delayed enforcement of the revised 45 CFR 180.50 requirements until April 1, 2026.

Sources

• CMS: CY 2026 OPPS and ASC Final Rule, Hospital Price Transparency Policy Changes (Nov 21, 2025)
• Federal Register: CY 2026 OPPS/ASC final rule (CMS-1834-FC)
• CMS: Hospital Price Transparency, Hospitals
• eCFR: 45 CFR 180.90 Civil monetary penalties
• CMS: Hospital Price Transparency FAQs

Related guides

• How to check your hospital machine-readable file
• The 2026 machine-readable file gap types