H.R. 7863 — Promoting Fairness for Medicare Providers Act of 2026

This section establishes a Medicare Part B payment methodology for specified high supply cost surgical procedures (defined based on procedures payable in 2023 under the ambulatory surgical center (ASC) prospective payment system and the physician fee schedule nonfacility rate that included a supply input exceeding $500) furnished in office-based facilities beginning in 2027, with annual review beginning in 2028 to add qualifying procedures. It (1) expands covered facility services under SSA §1832(a)(2)(F) to include such procedures; (2) amends SSA §1833(a)(1) to pay facility services at 80% of the amount determined under new SSA §1834(bb); and (3) under new §1834(bb), determines overall payment as if furnished in an ASC (excluding office-based treatment under §1833(i)(1)(B)), with facility services paid at 90% of the ASC facility payment under §1833(i) (or, for device-intensive procedures as defined in 42 C.F.R. §416.171(b)(2), the amount calculated under 42 C.F.R. §416.172(h)(2)(ii) with the non-device portion at 90%). It further limits beneficiary coinsurance for such facility services to the annual inpatient hospital deductible under SSA §1813(b), increasing provider payments under §1833(a)(1) by any excess coinsurance amount. (Thus, providers receive payment equivalent to full allowed charges up to the deductible cap.)