Off-campus provider-based departments need a separate NPI and a provider-based attestation (by December 31, 2027 for departments furnishing services on or before January 1, 2028), or lose OPPS payment from January 1, 2028
Published November 8, 2026 · Coverage November 1–7, 2026, Pacific · Medium priority
CMS codified section 6225 of the Consolidated Appropriations Act, 2026 at new 42 CFR 419.23 and 413.65(b)(6). No Outpatient Prospective Payment System (OPPS) payment may be made for items and services furnished on or after January 1, 2028, by an off-campus outpatient department unless the department has its own NPI separate from the main provider and the main provider has submitted an initial provider-based attestation. For departments furnishing services on or before January 1, 2028, initial attestations must be submitted between January 1, 2026 and December 31, 2027; a department is all hospital operations at one physical address listed in the Provider Enrollment, Chain, and Ownership System (PECOS). Before attesting, the main provider must obtain an NPI for each department and update PECOS. Departments that received an affirmative provider-based determination before January 1, 2026 must submit a new attestation. A timely attestation counts even if CMS has not issued a determination by the first date of service. CMS will use a standardized form and a centralized electronic system, will not require supporting documentation with the initial attestation, and will use risk-based review, remote audits and site visits; until the new system is final, attestations may go to the Medicare Administrative Contractor (MAC) under existing 413.65(b)(3)(ii).
Background
42 CFR 413.65 specifies the criteria for treating a facility as provider-based and the requirements for a CMS determination of provider-based status. Compliance with provider-based rules is mandatory, but since a law passed in 2000 a provider has needed to submit an attestation only if it wished to obtain a CMS determination, and payment had not been conditioned on verification of compliance. Section 6225 of the Consolidated Appropriations Act, 2026, enacted February 3, 2026, makes a separate NPI and a main-provider attestation conditions of payment under the OPPS (or a payment system under section 1833(t)(21)) for items and services an off-campus outpatient department furnishes on or after January 1, 2028.
Who this affects
Main providers (hospitals) with off-campus outpatient departments billed under the OPPS or under section 1833(t)(21) for non-excepted departments. Excluded from the attestation requirement: critical access hospital (CAH) off-campus departments, Indian Health Service (IHS) and tribal facilities under 413.65(m), and certain Federally Qualified Health Centers (FQHCs) and look-alikes under 413.65(n). No de minimis exception.
Why it matters
A hospital with off-campus outpatient departments paid under the outpatient payment system needs a department inventory by PECOS address, an NPI for each department, PECOS updates, claim-form changes to bill under the department NPI and, where the attestation requirement applies, an attestation. For departments furnishing services on or before January 1, 2028, the initial attestation window closes December 31, 2027. Inference: this is a multi-department project touching enrollment, billing systems and compliance attestation; the rule says a failure affects payment for the items and services furnished by the specific department. Inference: the attestation is a certification of compliance with 413.65, so it carries False Claims Act exposure if inaccurate; that is not stated in the rule.
Required actions
- Obtain a separate NPI for each off-campus outpatient department and update the enrollment record in PECOS before submitting an attestation
- Submit an initial provider-based attestation for each off-campus outpatient department furnishing services on or before January 1, 2028, between January 1, 2026 and December 31, 2027
- For departments that begin services after January 1, 2028, submit the initial attestation within the 2 years before delivering billed services
- From January 1, 2028, bill each off-campus department's items and services under its separate NPI
- Furnish supporting documentation on CMS or contractor request (CMS anticipates generally not more than 60 days)
Recommended action
- Build a department-by-address inventory against PECOS now and confirm on-campus and 250-yard status, and whether the department is within 35 miles of the main provider
- Pre-assemble 413.65(d), (e), (g) and (h) compliance evidence for each department
- Track release of the standardized attestation form and centralized system (draft format posted on the CMS-1850-FC page)
Scope and timing
- Authority status
- Final
- Responsible owner
- Compliance (primary); Provider Enrollment; Revenue Cycle; Legal
- Publication date
- 2026-11-06
- Effective date
- 2027-01-01
- Operative date
- 2028-01-01 (payment condition for items and services furnished on or after this date)
- Compliance date
- 2027-12-31 (last day to submit initial attestations for departments already furnishing services when the payment condition starts; the attestation window opened in 2026)
- Other dates
- Statute: Consolidated Appropriations Act (CAA), 2026 section 6225, enacted 2026-02-03; subsequent attestations within a period not to exceed 5 years, which CMS anticipates addressing in the 2028 rulemaking cycle
Not established
The attestation format file was not downloaded. Regulatory text of 419.23 and 413.65(b)(6) not read line by line. Whether earlier CMS or MAC guidance on section 6225 has issued since February 2026 was not searched.
Sources
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