The Fifth Circuit, sitting en banc, invalidated parts of federal No Surprises Act rules governing qualifying payment amount calculations on Aug. 11, 2026.
The ruling backed the Texas Medical Association on two issues, rejecting use of non-negotiated “ghost rates” such as $1 placeholders in QPA medians.
The court also struck down guidance excluding bonus and incentive payments from QPA, citing the statute’s “total maximum payment” standard.
The decision upheld excluding one-off single-case agreements from QPA calculations; further appeal or rehearing remains possible.
Insurers may need to recalculate QPAs once new rules are issued; current relief allows prior methods for services before Oct. 1, 2026.
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