Who has to follow it
The rule follows hospital licensing
For this rule, a hospital is a place licensed as a hospital under state or local law, or approved as meeting those licensing standards.
That is wider than Medicare. Taking Medicare doesn’t put a facility in the rule or take it out. What counts is how the place is licensed or approved where it operates.
CMS treats some government and tribal hospitals as already compliant. The rule names three groups: federally owned hospitals (including Veterans Affairs and Department of Defense hospitals), hospitals run by an Indian Health Program, and state hospitals that only treat people held by prison authorities.
What hospitals post
Two things, for two audiences
Part 180 asks for a full price file, plus an easy patient view of a smaller set of services you can plan ahead for.
The full price file
A CSV or JSON file with every standard price for every item and service. That covers the list price, the cash price, each insurer’s negotiated price, and the lowest and highest negotiated prices.
The patient view of common services
A searchable list, or a qualifying price estimator, for services you can usually schedule ahead. It covers as many of 70 services picked by CMS as the hospital offers, plus more the hospital chooses, for at least 300 in total when available.
The patient view must let people search by description, billing code and insurer, unless the hospital uses an estimator. An estimator counts if it covers the required services, gives an estimate of what you would owe the hospital, is easy to find, and works without a fee or an account.
The price file is a different thing. It is meant to be downloaded and processed by a computer, and it can hold millions of rows. A hospital can have a good patient estimator and a broken price file, or the other way round.
Posting and access
The file has to be easy to reach in practice
A public web address isn’t enough if a person or a program has to get past barriers to reach the data.
- No payment or account
- The file must be free, with no sign-up and no password.
- No personal details
- Getting the file can’t depend on giving your name, email or other personal information.
- Direct, automated access
- Programs must be able to find and download the file from a link on a public website.
- Searchable data
- The file and the prices inside it must be searchable by a computer.
- Standard file name
- The name follows a CMS pattern:
<ein>_<hospital-name>_standardcharges.csvor.json. - Signposts on the website
- The site keeps a pointer file at
/cms-hpt.txtand a footer link labeled “Price Transparency” that leads to the page hosting the price file.
The hospital also has to say which location the prices belong to. If sites under one license have different prices, each site must post its own.
Both the price file and the patient view must be updated at least once a year. The price file records its last update date. The patient view must show its update date clearly.
Timeline
The rule has gotten more specific
The main duty began in 2021. Later changes standardized how hospitals post and describe the data.
- Jan. 2021The posting rules took effectHospitals began posting a full price file and a patient view of common services.
- Jan. 2024Websites needed standard signpostsThe hospital’s website had to carry a
/cms-hpt.txtpointer file and a footer link labeled “Price Transparency.” - July 2024CMS templates became requiredPrice files had to follow a CMS template, its data rules and its data dictionary.
- Jan. 2025More detail became requiredThe template added the remaining fields for contract methods, allowed amounts, drug units and code modifiers.
- Jan. 2026The current rules took effectFiles now include a signed accuracy statement, a responsible senior official and organization ID numbers (NPIs). The single estimated allowed amount was replaced by 10th percentile, median and 90th percentile amounts plus a count.
- Apr. 2026CMS began enforcing the 2026 fieldsThe CMS technical guide gives April 1, 2026 as the date enforcement of the new template fields starts.
This timeline covers federal requirements only. A file made with an older template can still open fine, but a file that opens isn’t the same as a file in the current required format.
Enforcement
CMS decides who is compliant
CMS can look into complaints, review outside analyses, run audits, ask for documents or certifications, and do a full review.
If CMS decides a hospital isn’t following the rule, it can send a written warning. For a serious violation it can ask the hospital for a corrective action plan that lists the fixes and a timeline. If the hospital doesn’t respond, or doesn’t finish the approved plan, CMS can fine it and make the fine public.
The rule says these steps usually, but not always, happen in that order. CMS can also publish its findings and outcomes. When the same problem shows up across a health system, it can work with the system’s leaders.
This tracker
The tracker checks one slice of the rule
The automated check asks one thing: can an outsider find and read the hospital’s price file?
It starts with a hospital’s known website and asks for the standard pointer file. It matches an entry in that file to the hospital, follows the price file link, and reads enough of the file to check basic details. It looks at whether the file can be reached, which template version it names, and when it was last updated.
It doesn’t check every row. It doesn’t confirm that all negotiated prices are there, judge whether they are accurate, compare them with contracts, or test the patient lookup tool.
Some hospitals are matched to a file through reviewed evidence even when no usable pointer file exists. Those results keep their source and review notes. They aren’t presented as if the file had been found the standard way.
Reading results
Each label says what was observed
- File located
- A price file opened and passed the tracker’s checks for access, template version and freshness. The prices inside it were not verified.
- Issue observed
- A specific problem was observed, such as no pointer file, a dead link to the price file, an update date over a year old, or an outdated template. This is a note for review, not a legal finding.
- Request denied
- The website or file refused the tracker’s automated request. That prevents a result, so it is kept apart from problems seen in the file itself.
- Not assessed
- There was no usable website, the site didn’t respond, or a health-system pointer file couldn’t be confidently matched to this hospital.
- Exempt
- The project treats this hospital as outside the normal check. Most are covered by 45 CFR 180.30(b): federal hospitals, Indian Health Program hospitals and some state hospitals. Facilities with dated evidence that they have closed are listed here too.
Results are a snapshot on a date. Hospitals can swap files, fix links, change websites or reorganize after the check. The tracker keeps denied and not-assessed hospitals in view so you can see where the check couldn’t reach.
Sources