On May 22, 2025, the Centers for Medicare & Medicaid Services (CMS) took a series of actions to promote enhanced price transparency compliance by hospitals and identify challenges thereto, in order to inform future price transparency enforcement activities and policies. These actions were taken in furtherance of the President’s February 2025 Executive Order No. 14221 (which we previously analyzed here), and include the following actions of particular relevance for hospitals:

• CMS issued updated Price Transparency Guidance here emphasizing that:
  • Hospitals must include dollar amounts in their machine-readable files (MRFs) (if they can be calculated) in order to make hospital pricing more transparent, “including the amount negotiated for the item or service, the base rate negotiated for a service package, and a dollar amount if the standard charge is based on a percentage of a known fee schedule”; and
  • Hospitals should no longer include the code “999999999 (nine 9s)” in MRFs for estimated allowed amounts and “should instead encode an actual dollar amount.”
• CMS issued a Request for Information here (RFI) that is intended to “identify challenges and improve compliance and enforcement processes” related to hospital price transparency efforts, and specifically in connection with concerns regarding the “accuracy and completeness of” standard charge information in hospital MRFs.

The RFI seeks information from stakeholders in response to the following questions from CMS:

• Should CMS specifically define the terms “accuracy of data” and “completeness of data” in the context of HPT requirements, and, if yes, then how?
  • What are your concerns about the accuracy and completeness of the HPT MRF data? Please be as specific as possible.
  • Do concerns about accuracy and completeness of the MRF data affect your ability to use hospital pricing information effectively? For example, are there additional data elements that could be added, or others modified, to improve your ability to use the data? Please provide examples.
  • Are there external sources of information that may be leveraged to evaluate the accuracy and completeness of the data in the MRF? If so, please identify those sources and how they can be used.
  • What specific suggestions do you have for improving the HPT compliance and enforcement processes to ensure that the hospital pricing data is accurate, complete, and meaningful? For example, are there any changes that CMS should consider making to the CMS validator tool, which is available to hospitals to help ensure they are complying with HPT requirements, so as to improve accuracy and completeness?
  • Do you have any other suggestions for CMS to help improve the overall quality of the MRF data?

Responses to the CMS RFI are due by midnight on July 21, 2025, and must be submitted on that same webpage. CMS is interested in feedback from a variety of stakeholders who interact with MRFs and/or rely on the price transparency tools, including hospitals, payers, employers, innovators, and consumers.

We will continue to monitor oversight and enforcement of federal price transparency laws, and the impact these activities may have on hospitals and other health care organizations.