Spending: rising, and faster than the economy
The National Health Expenditure projections from the CMS Office of the Actuary are the standard federal forecast of US health spending. The current release covers 2025 through 2034 (CMS NHE Projections, 2026 release):
| Measure | 2025 | 2026 | Average, 2025–34 |
|---|---|---|---|
| National health expenditures | +7.3% | +6.3% | +5.4% a year |
| Hospital spending | +8.2% | +5.8% | +5.2% a year |
| Physician and clinical services | +6.2% | +5.6% | +5.5% a year |
| Out-of-pocket spending | +6.2% | +6.2% | not stated as one figure |
The actuaries project health spending to outgrow the economy: 5.4% a year against average GDP growth of 4.1%. That would lift health care's share of GDP from 18.0% in 2024 to 20.6% by 2034. The forecast puts total spending at about $5.7 trillion in 2025.
Spending growth isn't the same thing as price growth. It combines prices, how much care people use, and the mix of services. For someone planning surgery, the line that matters most is out-of-pocket spending, projected to rise 6.2% in both 2025 and 2026. That's what patients pay directly, through deductibles, coinsurance and self-pay bills.
Surgeon fees under Medicare: the headline rise has a catch
Medicare's physician fee schedule matters well beyond Medicare patients. It's the most widely used public benchmark for professional fees. For 2026, CMS set two conversion factors: $33.57 for clinicians in qualifying alternative payment models, and $33.40 for everyone else. Both are up from $32.35 in 2025, rises of 3.77% and 3.26% (CMS PFS final rule fact sheet, October 2025).
CMS also finalized a −2.5% "efficiency adjustment." It applies to all codes except time-based ones. CMS lists the exempt time-based groups as office and hospital visits, care management, behavioral health, telehealth-list services and certain maternity codes. Surgical procedure codes are not in those exempt groups, so the adjustment reduces their value. For a surgeon's fee benchmarked to Medicare, part of the conversion-factor rise is cancelled out. The net effect varies by procedure.
Anesthesia uses its own conversion factor, and the CMS fact sheet doesn't state the 2026 figure. For how anesthesia time is billed, see how surgery length changes anesthesia and facility costs.
Facility payments: a modest rise
For hospital outpatient departments and ambulatory surgery centers (ASCs), CMS finalized a 2026 payment update of 2.6% for facilities that meet quality-reporting requirements. That's a 3.3% market-basket increase minus a 0.7-point productivity adjustment (CMS OPPS/ASC final rule fact sheet, November 2025). That's below the 5.8% growth in hospital spending projected for the same year. It suggests that more of the growth comes from how much care is used and the mix of services than from Medicare's outpatient rates.
Where prices could fall: operations moving out of the hospital
The biggest structural change in 2026 is about where surgery happens:
- The inpatient-only list is being phased out. This list names procedures Medicare pays for only when performed as inpatient hospital care. CMS is phasing it out over three years starting in 2026, and removed 285 procedures in the first year, mostly musculoskeletal (CMS, November 2025).
- Surgery centers can do more. CMS added 560 codes to the ASC covered procedures list for 2026. That's 289 through revised criteria, plus 271 codes that came off the inpatient-only list.
For patients, this can mean more choice of setting. Outpatient and ASC care is often priced differently from an inpatient stay, and with no overnight room charge it is frequently lower. Whether a given patient is suitable for outpatient surgery is still a clinical decision. Our guide to same-day surgery vs a hospital stay explains how the setting changes what you're billed for.
Prices getting easier to see
Hospital price-transparency rules also tightened on January 1, 2026. Hospitals that set negotiated rates as percentages or by formula must now publish the median, 10th-percentile and 90th-percentile allowed amounts, and how many allowed amounts those figures are based on. Hospitals must also attest that their published data is complete and accurate, and name a senior official. CMS delayed enforcement of the new data elements until April 1, 2026 (CMS, November 2025). Percentile data is a step forward because it shows a range of what insurers actually paid, not a single list price. It still doesn't tell you your own bill. Physician fees, anesthesia and other professionals often sit outside a hospital's file.
Rising, falling or steady: a 2026 summary
| Force | Direction for 2026 | What it means for a surgery budget |
|---|---|---|
| Total and hospital spending | Rising (6.3% and 5.8% projected) | Expect 2026 quotes to be higher than older published ranges |
| Out-of-pocket spending | Rising (6.2% projected) | The patient share keeps growing |
| Medicare physician conversion factor | Up 3.26%–3.77% | Visits and other time-based services gain the most |
| Procedure code values | Pressure down (−2.5% efficiency adjustment) | Offsets part of the rise for surgical fees benchmarked to Medicare |
| Outpatient and ASC rates | Up 2.6% | A modest increase in facility benchmarks |
| Site of care | Shifting toward outpatient and ASC | Possible savings where a lower-cost setting is clinically suitable |
| Price transparency | More detailed data | Better ranges to check quotes against |
Planning surgery for late 2026 or 2027
Trend data can't price your operation, but it can shape how you plan for it:
- Watch the timing against your plan year. If you have insurance, find out when your deductible and out-of-pocket maximum reset. With out-of-pocket spending projected to keep rising, surgery just before or just after a reset can mean a very different bill for the same operation.
- Ask whether a different setting is possible. With hundreds of procedures newly eligible for surgery centers, ask your surgeon whether your operation could be done in an outpatient department or ASC. If so, get a quote for each setting.
- Check quotes against the new percentile data. If a hospital publishes 10th, median and 90th-percentile allowed amounts for your procedure, see where your quote falls in that range. Remember the file may leave out professional fees.
- Get the expiry date in writing. In a year when prices are rising, a quote with no expiry date, or one that expires before your surgery date, may be repriced.
- Don't rely on old averages. Ranges from earlier years, including the 2018 hospital-cost data used elsewhere on this site, help with scale and ranking, not with what you'll pay now.
The international side: what to watch
None of the federal data above covers prices abroad, and we don't have an equivalent official series for surgery prices in Colombia or other destinations. Rather than quote one, here are the variables that move an international comparison from year to year:
- Exchange rates. A quote in local currency changes in dollar terms whenever the exchange rate moves, even if the clinic's price doesn't. Our guide to currency exchange and your surgery bill covers how to handle that.
- The US comparison point. When US out-of-pocket costs rise, the gap a patient sees widens, even if prices abroad stay the same.
- How old the quote is. A quote or published range from a year or more ago reflects neither year's prices. Check the date on every number you compare, including the ones on this site.
The Takeaway
The 2026 trend is mixed. Overall and out-of-pocket spending keep rising faster than the economy. Medicare is trimming procedure code values and pushing operations toward outpatient settings, and hospital price data is getting more detailed. For your own surgery, that means getting a dated, current quote and asking whether a lower-cost setting suits you. Don't rely on last year's averages.
Sources: CMS Office of the Actuary, NHE Projections 2025–2034, forecast summary (2026); CMS, CY 2026 Physician Fee Schedule final rule fact sheet (October 31, 2025); CMS, CY 2026 OPPS/ASC final rule fact sheet (November 21, 2025). Educational content, not financial advice.
Frequently asked questions
Are surgery prices going up in 2026?
Overall spending is. CMS actuaries project national health spending to grow 6.3% in 2026, hospital spending 5.8% and out-of-pocket spending 6.2%. Spending growth mixes prices with how much care people use, so individual procedure prices can move differently.
Did Medicare raise surgeon payments for 2026?
The conversion factor rose 3.26% to 3.77%, depending on alternative-payment-model status. A −2.5% efficiency adjustment applies to non-time-based codes, which include surgical procedures, so part of that rise is cancelled out for surgery.
What is the inpatient-only list, and why does its phase-out matter?
It lists procedures Medicare pays for only when they're done as inpatient hospital care. CMS began a three-year phase-out in 2026, removing 285 procedures, mostly musculoskeletal. Some of those operations can now be done in outpatient settings, which may cost less where they're clinically suitable.
Can I see what hospitals charge for surgery in 2026?
Hospitals must publish standard charges. From 2026, some must also show the median and 10th- and 90th-percentile allowed amounts. Those are useful ranges, but they don't include every professional fee and they aren't your personal bill.
Are prices abroad rising too?
We don't have an official series comparable to the US data. In dollar terms, prices abroad move with exchange rates as well as with clinic pricing. Always check the date and currency on any quote or published range.