New Provider-Based Requirements for Off-Campus Hospital Outpatient Departments

On February 3, 2026, Congress enacted the Consolidated Appropriations Act of 2026 (the Act), which includes amendments to the Medicare provider-based billing requirements for off-campus hospital outpatient departments. Specifically, the Act requires hospitals to obtain a separate National Provider Identifier (NPI) and submit provider-based attestations for each off-campus outpatient department. Hospitals must comply with these new requirements before January 1, 2028 to continue receiving Medicare payment under the Outpatient Prospective Payment System (OPPS) (or any other applicable payment system) for items or services furnished in these departments.

Explanation of the New Requirements

Off-Campus Provider-Based Departments

The new requirements specifically apply to any “off-campus outpatient department of a provider,” generally defined as any department of a provider (as defined in 42 C.F.R. § 413.65)  that is located more than 250 yards from the main campus of a hospital or from a remote location of a hospital.

New Mandatory Attestation Requirements

Historically, submission of a provider-based attestation has been voluntary. Through this process, a hospital certifies a department’s compliance with provider-based requirements and its qualification to receive more favorable Medicare reimbursement under the hospital OPPS. The Act makes the attestation process mandatory for all off-campus provider-based departments and requires the following attestations:

1. Hospitals must submit an initial provider-based attestation prior to December 31, 2027 for any existing off-campus outpatient department of a provider.
2. Thereafter, hospitals must submit subsequent attestations in accordance with a timeframe to be specified by the Secretary of the Department of Health and Human Services (HHS).

Under the new law, the Centers for Medicare & Medicaid Services (CMS) is responsible for establishing a process for providers to submit the required initial and subsequent attestations. Until that process is established, providers may submit attestations under the existing voluntary framework set forth at 42 C.F.R. § 413.65(b)(3).

Separate NPI

Hospitals must now obtain a separate NPI for each off-campus provider-based department, and items and services furnished on or after January 1, 2028 in any such department must be billed under this separate NPI.

Next Steps

Addressing these new provider-based requirements will require significant time and effort from affected hospitals. Hospitals and health systems should begin right away by identifying all off-campus provider-based departments and evaluating each department’s compliance with the provider-based rules. CMS will issue rules that further define these new requirements, in the meantime, hospitals can begin preparing attestations and NPI applications for applicable departments.

If you have any questions or need assistance addressing these new requirements, please contact the authors listed below.