CMS issues updated hospital price transparency guidance

Modern Healthcare – Thursday, May 22, 2025
By Bridget Early

The Centers for Medicare and Medicaid Services on Thursday began implementing revised hospital price transparency requirements.

As part of a February executive order enhancing oversight of price transparency requirements enacted in 2021, CMS issued new guidance requiring hospitals to post the actual prices of its products and services, rather than estimates. The agency is also soliciting public feedback on how it can boost hospital compliance by providing understandable pricing data.

“Transparency in healthcare is essential, not optional,” Stephanie Carlton, CMS chief of staff and deputy administrator, said in a news release. “Americans deserve to know exactly what they’re paying for and what they’re getting in return.”

On Feb. 25, President Trump gave the Treasury, Labor, and Health and Human Services Departments 90 days to issue new rules or guidance to ensure pricing data can be easily compared across health systems and insurers, including by requiring hospitals to list specific prices. It also called on regulators to strengthen enforcement for noncompliance.

The executive order raised concerns across the industry that the administration might increase its scrutiny of the industry’s compliance with existing price transparency regulations. CMS has issued 10 penalties so far this year for noncompliance, compared with three for all of 2024.

In its new guidance, CMS is requiring hospitals to include a “standard charge dollar amount” in its machine-readable files whenever possible.

This should include gross charges, cash prices, payer-specific negotiated rates and any minimum negotiated charges — the lowest charge a hospital can negotiate for products and services across all payers.

“CMS expects that, for most contracting scenarios, hospitals’ payer-specific negotiated charges can be expressed as a dollar amount,” according to the guidance.

In cases where hospitals cannot list charges in actual amounts, CMS says charges should be listed as percentages, with additional details provided elsewhere in the data file explaining the factors used to calculate them.

“The AHA supports price transparency and recognizes the importance of compliance with the regulations regarding both hospital and insurance price transparency,” said Ariel Levin, director of policy at the American Hospital Association, in a statement. “We are reviewing today’s proposals in detail and welcome further collaboration with the administration to ensure that patients are able to get the information they need to make informed decisions about their care.”

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