Promoting Fairness for Medicare Providers Act of 2026

Limits out-of-pocket costs for patients: For individuals receiving specified high supply cost surgical procedures in an office-based facility, the amount of coinsurance for facility services cannot exceed the inpatient hospital deductible amount. (Section 2(a)(2)(3)(A))

Provides specific payment structures for high-cost procedures: The bill establishes that payment for these specific procedures in an office-based facility will be determined in a manner similar to how they are paid for in an ambulatory surgical center. (Section 2(a)(2)(1))

Ensures payment to providers when patient costs are capped: If a patient's required coinsurance would normally exceed the inpatient hospital deductible due to the new cap, the Secretary must increase the amount paid to the office-based facility to cover the difference. (Section 2(a)(2)(3)(B))

Requires specific agreements from physician offices: To qualify as an "office-based facility" under this act, a physician's office must enter into an agreement with the Secretary to accept the determined payment amount as full payment and accept assignment for all such facility services. (Section 2(a)(2)(5)(B))

Subjects offices to specific health and safety standards: Physician offices acting as office-based facilities must meet health, safety, and other standards specified by the Secretary in regulations. (Section 2(a)(2)(5)(A))