Trump administration proposes Medicare payment equalization for routine hospital imaging

Centers for Medicare and Medicaid Services would reduce Medicare payments to hospitals for outpatient imaging such as X-rays, ultrasounds, and MRIs, aligning reimbursement more closely with rates paid when the same services are performed in doctor’s offices.

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President Donald Trump’s administration, through the Centers for Medicare and Medicaid Services, has released a proposed rule that would reduce Medicare payments to hospitals for certain routine outpatient imaging services, according to reporting from The Hill and other outlets. The change is aimed at narrowing what the administration describes as site-of-care payment gaps, which it says have helped drive higher spending for Medicare beneficiaries.

Under the approach described by reporters, Medicare would pay hospitals less for outpatient scans when those services are performed in hospital settings, putting payments more in line with what Medicare pays physician offices for comparable imaging. The services discussed include X-rays, ultrasounds, MRIs, and other routine imaging done in hospital outpatient departments.

The Hill’s report characterizes the proposal as a move to “equalize” payment rates between hospitals and doctor’s offices for imaging. A separate report focused on the White House’s explanation similarly said hospitals would no longer be able to receive higher Medicare payments for routine imaging than doctors do for the same services.

The proposed rule is also described as part of a broader CMS agenda affecting hospital reimbursement and drugs. Healthcare Dive reported that the administration’s proposed 2027 Medicare payment changes build on other priorities, including addressing discounts under the 340B program and expanding “site-neutral” payment approaches beyond earlier efforts.

KFF previously described CMS’s earlier iterations of site-neutral payment reforms, including changes to hospital outpatient prospective payment policy. In the current reporting, the administration is advancing a more expansive site-neutral framework for imaging that would take effect for future reimbursement years, pending a finalized rule after public comment.

Hospital groups and provider advocates have historically objected to site-neutral payment expansions, arguing hospitals treat sicker patients and face different overhead and operating conditions than physician offices. Under the current proposal as summarized by the news reports, those disputes are expected to carry into the formal notice-and-comment process.

The next step is CMS’s standard federal rulemaking timeline: the proposal would be published for public review, stakeholders would submit comments, and CMS would issue a final rule before implementation. The ultimate beneficiary impact depends on how CMS finalizes payment rates and the scope of services subject to reduced hospital payments.

Why It Matters

The proposal, if finalized as described, would change how Medicare pays hospitals for outpatient imaging, affecting both hospital revenue and beneficiary costs through reimbursement and insurance payment dynamics.
The timing matters because site-neutral imaging policies typically apply prospectively through annual Medicare payment rule cycles, meaning affected services and payment rates could shift for future reimbursement years after a final CMS decision.
The dispute over site-neutral policy highlights recurring questions about federal reimbursement design for different care settings, including whether payment differences reflect clinically appropriate costs or lead to unnecessary spending.
The proposal also intersects with other hospital payment reforms described by multiple outlets, which could broaden the cumulative financial impact on hospitals that rely on outpatient imaging and related revenue streams.

Sources

Key Facts

CMS has released a proposed rule that would reduce Medicare payments to hospitals for certain routine outpatient imaging services such as X-rays, ultrasounds, and MRIs.
The policy is described in reporting as a site-neutral payment equalization effort, aligning hospital outpatient imaging reimbursement more closely with what Medicare pays physician offices for comparable services.
The Hill reported the proposal as part of a broader effort to curb Medicare payment differences between sites of care, with potential cost impacts for seniors.
Other outlets reported the imaging change is tied to a larger CMS package that also addresses reimbursement issues involving 340B drug discounts and expanded site-neutral policies.
The change would proceed through the federal rulemaking process, with public comments and a final rule required before taking effect.