The Honorable Mehmet C. Oz, MD. MBA
Administrator
Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
ATTN: CMS-1834-P
P.O. Box 8013
Baltimore, MD 21244-1850
Subject: CMS-1834-P, CY 2026 Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Ratings; and Hospital Price Transparency.
Dear Administrator Oz:
On behalf of the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS), representing more than 4,000 neurosurgeons nationwide, we appreciate the opportunity to comment on the above-referenced notice of proposed rulemaking.
EXECUTIVE SUMMARY
Outpatient Prospective Payment System Issues
- Inpatient Only List. We believe the site of service should be determined by the surgeon in consultation with the patient. We are concerned that the agency has not clearly indicated how it will protect access to the inpatient setting when necessary without overly burdensome requirements, such as preauthorization for inpatient admission. Therefore, we urge the agency not to implement its proposal to eliminate the Inpatient Only (IPO) list beginning in CY 2026. Inpatient admission should remain an option for patients who require that level of care. The IPO list should not be completely phased out until CMS has a plan to protect patients who need the inpatient setting. We would support a more measured approach and note that even when a procedure comes off the IPO, inpatient admission should remain an option for patients who require that level of care. 2
- Facility Payment Reporting for Annular Closure Devices. We support the CMS proposal to maintain HCPCS code C9757 with its current Ambulatory Payment Classification (APC) and status indicator for outpatient facility reporting in 2026 for annular closure devices. A new CPT add-on code will be used for physician payment. Still, given concerns about the CMS recognition of the additional resources in an add on code, use of the C code for facility payment is reasonable.
- APC Re-assignment for Neurostimulators. We urge CMS to re-assign CPT code 61891 (Revision or Replacement of a Skull-Mounted Cranial Neurostimulator) from APC 5464 Level 4 to APC 5465 Level 5.
Click here to view the full Neurosurgery Comments on CY 2026 Medicare Hospital OPPS ASC Proposed Rule.
