Internal Revenue Bulletin 2025-47

Official source: Internal Revenue Bulletin (https://www.irs.gov/pub/irs-irbs/irb25-47.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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These synopses are intended only as aids to the reader in identifying the subject matter covered. They may not be relied upon as authoritative interpretations.

This notice provides the indexing factors to be used by group health plans and health insurance issuers to calculate the qualifying payment amount (QPA) for items or services provided on

Finding Lists begin on page ii.

or after January 1, 2026, and before January 1, 2027. The QPA is the basis for determining individual cost sharing for items and services covered by the balance-billing protections in the No Surprises Act (NSA), under certain circumstances. The QPA for a given calendar year is based on information regarding median rates for certain items and services from prior years and is indexed based on changes in the consumer price index.

Provide America’s taxpayers top-quality service by helping them understand and meet their tax responsibilities and enforce the law with integrity and fairness to all.

The Internal Revenue Bulletin is the authoritative instrument of the Commissioner of Internal Revenue for announcing official rulings and procedures of the Internal Revenue Service and for publishing Treasury Decisions, Executive Orders, Tax Conventions, legislation, court decisions, and other items of general interest. It is published weekly.

It is the policy of the Service to publish in the Bulletin all substantive rulings necessary to promote a uniform application of the tax laws, including all rulings that supersede, revoke, modify, or amend any of those previously published in the Bulletin. All published rulings apply retroactively unless otherwise indicated. Procedures relating solely to matters of internal management are not published; however, statements of internal practices and procedures that affect the rights and duties of taxpayers are published.

Revenue rulings represent the conclusions of the Service on the application of the law to the pivotal facts stated in the revenue ruling. In those based on positions taken in rulings to taxpayers or technical advice to Service field offices, identifying details and information of a confidential nature are deleted to prevent unwarranted invasions of privacy and to comply with statutory requirements.

Rulings and procedures reported in the Bulletin do not have the force and effect of Treasury Department Regulations, but they may be used as precedents. Unpublished rulings will not be relied on, used, or cited as precedents by Service personnel in the disposition of other cases. In applying published rulings and procedures, the effect of subsequent legislation, regulations, court decisions, rulings, and procedures must be considered, and Service personnel and others concerned are cautioned

against reaching the same conclusions in other cases unless the facts and circumstances are substantially the same.

The Bulletin is divided into four parts as follows:

Part I.—1986 Code. This part includes rulings and decisions based on provisions of the Internal Revenue Code of 1986.

Part II.—Treaties and Tax Legislation. This part is divided into two subparts as follows: Subpart A, Tax Conventions and Other Related Items, and Subpart B, Legislation and Related Committee Reports.

Part III.—Administrative, Procedural, and Miscellaneous. To the extent practicable, pertinent cross references to these subjects are contained in the other Parts and Subparts. Also included in this part are Bank Secrecy Act Administrative Rulings. Bank Secrecy Act Administrative Rulings are issued by the Department of the Treasury’s Office of the Assistant Secretary (Enforcement).

Part IV.—Items of General Interest. This part includes notices of proposed rulemakings, disbarment and suspension lists, and announcements.

The last Bulletin for each month includes a cumulative index for the matters published during the preceding months. These monthly indexes are cumulated on a semiannual basis, and are published in the last Bulletin of each semiannual period.

The contents of this publication are not copyrighted and may be reprinted freely. A citation of the Internal Revenue Bulletin as the source would be appropriate.

November 17, 2025 Bulletin No. 2025–47

26 CFR 54.9816-6T: Calculating the qualifying payment amount in 2026

Pursuant to Treas. Reg. § 54.98166T(c), 29 CFR 2590.716-6(c), and 45 CFR 149.140(c), this notice provides the percentage increase for calculating the qualifying payment amounts (QPAs) for items and services furnished during 2026 for purposes of sections 9816 and 9817 of the Internal Revenue Code (Code), sections 716 and 717 of the Employee Retirement Income Security Act of 1974 (ERISA), and sections 2799A-1 and 2799A-2 of the Public Health Service Act (PHS Act). These provisions, added by the No Surprises Act, ¹ provide protections against surprise medical bills in certain circumstances. Similar guidance for items and services furnished during 2022, 2023, 2024, and 2025 was published in Revenue Procedure 2022-11, Notice 2022-11, Notice 2023-4, Notice 2024-1, and Notice 2025-12. ²

The QPA serves as the basis for calculating patient cost sharing for items or services subject to the surprise billing provisions of the No Surprises Act in certain circumstances. The QPA is also one of the factors considered by a certified indepen

dent dispute resolution (IDR) entity to determine which of two offers submitted by parties to a payment dispute in the Federal IDR process best represents the value of a qualified IDR item or service as the out-of-network rate.

The QPA is generally the median of the contracted rates recognized by the plan or issuer on January 31, 2019, for the same or similar item or service that is provided by a provider in the same or similar specialty or a facility of the same or similar facility type and provided in the geographic region in which the item or service is furnished, increased for inflation. Pursuant to Treas. Reg. § 54.9816-6T(c), 29 CFR 2590.716-6(c), and 45 CFR 149.140(c), plans and issuers were first required to calculate the QPA for items and services furnished during 2022. Thus, 2019 generally is the base year for items and services furnished in 2022, increased for all subsequent years. The median contracted rate is determined with respect to all plans of the plan sponsor or all coverage offered by the issuer that are offered in the same insurance market. In general, for years after 2022, the plan or issuer must calculate the QPA by increasing the QPA determined for an item or service furnished in the immediately preceding year by the percentage increase, as published in annual guidance. QPAs determined based on later years (for example, QPAs for group health plans or health insurance issuers not offering coverage in 2019 or items or services not covered in 2019) are adjusted based on the year for which the QPA is first determined.

The percentage increase in the CPI-U over a preceding year is calculated by dividing the average CPI-U for the preceding year by the average CPI-U for the year immediately prior to the preceding year. For this purpose, the average CPI-U for a year is the average of the monthly CPI-Us published by the Bureau of Labor Statistics of the Department of Labor for the 12-month period ending on August 31 of each year, rounded to 10 decimal places. The percentage increase in the CPI-U for items and services provided in 2026 over the preceding year is the average CPI-U for 2025 over the average CPI-U for 2024. Pursuant to this calculation, the percentage increase from 2025 to 2026 is 1.0265311701. Further, pursuant to prior notices, plans and issuers may round any resulting QPAs to the nearest dollar.

To calculate the adjusted QPA, the prior year’s adjusted QPA is multiplied by the percentage increase for the most recent year. To simplify this calculation, this notice provides cumulative percentage increases. To calculate the adjusted QPA for items and services furnished in 2026 using the cumulative percentage increase, the “base year” QPA is multiplied by the cumulative percentage increase for the year the base QPA originated. A plan or issuer may choose whether to use the cumulative percentage increase or the percentage increase, but the selected method must be applied consistently for all QPAs calculated for items and services furnished during 2026. A plan or issuer is not permitted to use one method for certain QPAs and a different method for other QPAs.

1 The No Surprises Act was enacted as Title I of Division BB of the Consolidated Appropriations Act, 2021, Pub. L. 116-260, 134 Stat. 1182 (2020).

2 Revenue Procedure 2022-11, 2022-3 IRB 449; Notice 2022-11, 2022-14 IRB 939, Notice 2023-4, 2023-2 IRB 321, Notice 2024-1, 2023-2 IRB 314, and Notice 2025-12, 2025-8 IRB 813.

Bulletin No. 2025–47 717 November 17, 2025

See Notice 2024-1 and Notice 2025-12 regarding the application of these percentage increases.

The effective date of this notice is January 1, 2026.

INFORMATION

The principal author of this notice is the Office of Associate Chief Counsel (Employee Benefits, Exempt Organizations, and Employment Taxes). For further information regarding this notice,

contact 202-317-5500 (not a toll-free number).

November 17, 2025 718 Bulletin No. 2025–47

new ruling does more than restate the substance of a prior ruling, a combination of terms is used. For example, modified and superseded describes a situation where the substance of a previously published ruling is being changed in part and is continued without change in part and it is desired to restate the valid portion of the previously published ruling in a new ruling that is self contained. In this case, the previously published ruling is first modified and then, as modified, is superseded.

Supplemented is used in situations in which a list, such as a list of the names of countries, is published in a ruling and that list is expanded by adding further names in subsequent rulings. After the original ruling has been supplemented several times, a new ruling may be published that includes the list in the original ruling and the additions, and supersedes all prior rulings in the series.

Revenue rulings and revenue procedures (hereinafter referred to as “rulings”) that have an effect on previous rulings use the following defined terms to describe the ­effect:

Amplified describes a situation where no change is being made in a prior published position, but the prior position is being extended to apply to a variation of the fact situation set forth therein. Thus, if an earlier ruling held that a principle applied to A, and the new ruling holds that the same principle also applies to B, the earlier ruling is amplified. (Compare with modified, below).

Clarified is used in those instances where the language in a prior ruling is being made clear because the language has caused, or may cause, some confusion. It is not used where a position in a prior ruling is being changed.

Distinguished describes a situation where a ruling mentions a previously published ruling and points out an essential difference between them.

where a ruling mentions a previously pub- the 1986 Code and regulations the same Suspended is used in rare situations lished ruling and points out an essential position published under the 1939 Code to show that the previous published ruldifference between them. and regulations. The term is also used ings will not be applied pending some

Modified is used where the substance when it is desired to republish in a single future action such as the issuance of new of a previously published position is being ruling a series of situations, names, etc., or amended regulations, the outcome of changed. Thus, if a prior ruling held that a that were previously published over a cases in litigation, or the outcome of a principle applied to A but not to B, and the period of time in separate rulings. If the Service study.

Modified is used where the substance of a previously published position is being changed. Thus, if a prior ruling held that a principle applied to A but not to B, and the

new ruling holds that it applies to both A and B, the prior ruling is modified because it corrects a published position. (Compare with amplified and clarified, above).

Obsoleted describes a previously published ruling that is not considered determinative with respect to future transactions. This term is most commonly used in a ruling that lists previously published rulings that are obsoleted because of changes in laws or regulations. A ruling may also be obsoleted because the substance has been included in regulations subsequently adopted.

Revoked describes situations where the position in the previously published ruling is not correct and the correct position is being stated in a new ruling.

Superseded describes a situation where the new ruling does nothing more than restate the substance and situation of a previously published ruling (or rulings). Thus, the term is used to republish under the 1986 Code and regulations the same position published under the 1939 Code and regulations. The term is also used when it is desired to republish in a single ruling a series of situations, names, etc., that were previously published over a period of time in separate rulings. If the

PTE —Prohibited Transaction Exemption. Pub. L. —Public Law. REIT —Real Estate Investment Trust. Rev. Proc. —Revenue Procedure. Rev. Rul. —Revenue Ruling. S —Subsidiary. S.P.R. —Statement of Procedural Rules. Stat. —Statutes at Large. T —Target Corporation. T.C. —Tax Court. T.D. —Treasury Decision. TFE —Transferee. TFR —Transferor. T.I.R. —Technical Information Release. TP —Taxpayer. TR —Trust. TT —Trustee. U.S.C. —United States Code. X —Corporation. Y —Corporation. Z —Corporation.

The following abbreviations in current use and formerly used will appear in material published in the Bulletin.

A —Individual. Acq. —Acquiescence. B —Individual. BE —Beneficiary. BK —Bank. B.T.A. —Board of Tax Appeals. C —Individual. C.B. —Cumulative Bulletin. CFR —Code of Federal Regulations. CI —City. COOP —Cooperative. Ct.D. —Court Decision. CY —County. D —Decedent. DC —Dummy Corporation. DE —Donee. Del. Order —Delegation Order. DISC —Domestic International Sales Corporation. DR —Donor. E —Estate. EE —Employee. E.O. —Executive Order. ER —Employer.

ERISA —Employee Retirement Income Security Act. EX —Executor. F —Fiduciary. FC —Foreign Country. FICA —Federal Insurance Contributions Act. FISC —Foreign International Sales Company. FPH —Foreign Personal Holding Company. F.R. —Federal Register. FUTA —Federal Unemployment Tax Act. FX —Foreign corporation. G.C.M. —Chief Counsel’s Memorandum. GE —Grantee. GP —General Partner. GR —Grantor. IC —Insurance Company. I.R.B. —Internal Revenue Bulletin. LE —Lessee. LP —Limited Partner. LR —Lessor. M —Minor. Nonacq. —Nonacquiescence. O —Organization. P —Parent Corporation. PHC —Personal Holding Company. PO —Possession of the U.S. PR —Partner. PRS —Partnership.

Bulletin No. 2025–47 i November 17, 2025

Numerical Finding List ¹

Bulletin 2025–47

Announcements:

2025-19, 2025-29 I.R.B. 191 2025-20, 2025-31 I.R.B. 271 2025-21, 2025-32 I.R.B. 312 2025-24, 2025-36 I.R.B. 359 2025-25, 2025-36 I.R.B. 360 2025-26, 2025-40 I.R.B. 444

Notices:

2025-32, 2025-27 I.R.B. 1 2025-33, 2025-27 I.R.B. 4 2025-34, 2025-27 I.R.B. 6 2025-35, 2025-27 I.R.B. 8 2025-31, 2025-28 I.R.B. 14 2025-36, 2025-30 I.R.B. 192 2025-37, 2025-30 I.R.B. 198 2025-40, 2025-31 I.R.B. 266 2025-39, 2025-32 I.R.B. 308 2025-28, 2025-34 I.R.B. 316 2025-41, 2025-34 I.R.B. 325 2025-42, 2025-36 I.R.B. 351 2025-43, 2025-36 I.R.B. 356 2025-44, 2025-37 I.R.B. 386 2025-45, 2025-37 I.R.B. 388 2025-38, 2025-38 I.R.B. 392 2025-47, 2025-40 I.R.B. 441 2025-51, 2025-41 I.R.B. 448 2025-52, 2025-41 I.R.B. 474 2025-54, 2025-41 I.R.B. 479 2025-46, 2025-43 I.R.B. 533 2025-50, 2025-43 I.R.B. 542 2025-53, 2025-43 I.R.B. 624 2025-55, 2025-43 I.R.B. 625 2025-49, 2025-44 I.R.B. 627 2025-57, 2025-45 I.R.B. 692 2025-61, 2025-45 I.R.B. 693 2025-63, 2025-46 I.R.B. 709 2025-65, 2025-47 I.R.B. 717

Proposed Regulations:

REG-125710-18, 2025-30 I.R.B. 263 REG-107459-24, 2025-32 I.R.B. 313 REG-132805-17, 2025-35 I.R.B. 342 REG-108822-25, 2025-36 I.R.B. 361 REG-129260-16, 2025-39 I.R.B. 410 REG-108673-25, 2025-42 I.R.B. 494 REG-110032-25, 2025-42 I.R.B. 495 REG-112261-24; REG-116085-23, 2025-42 I.R.B. 522 REG-109742-25, 2025-46 I.R.B. 712

Revenue Procedures:

2025-22, 2025-30 I.R.B. 200 2025-24, 2025-31 I.R.B. 273 2025-25, 2025-32 I.R.B. 311 2025-26, 2025-33 I.R.B. 315 2025-28, 2025-38 I.R.B. 393 2025-30, 2025-42 I.R.B. 489 2025-27, 2025-44 I.R.B. 646 2025-32, 2025-45 I.R.B. 695

Revenue Rulings:

2025-13, 2025-28 I.R.B. 11 2025-14, 2025-32 I.R.B. 300 2025-15, 2025-32 I.R.B. 302 2025-16, 2025-35 I.R.B. 342 2025-17, 2025-36 I.R.B. 349 2025-18, 2025-37 I.R.B. 365 2025-19, 2025-41 I.R.B. 445 2025-20, 2025-41 I.R.B. 447 2025-21, 2025-45 I.R.B. 690

Treasury Decisions:

10021, 2025-31 I.R.B. 264 10031, 2025-32 I.R.B. 304 10033, 2025-40 I.R.B. 411 10035, 2025-42 I.R.B. 484 10034, 2025-43 I.R.B. 523 10036, 2025-43 I.R.B. 525

1 A cumulative list of all revenue rulings, revenue procedures, Treasury decisions, etc., published in Internal Revenue Bulletins 2025–27 through 2025–52 is in Internal Revenue Bulletin 2025–52, dated December 22, 2025.

November 17, 2025 ii Bulletin No. 2025–47

Finding List of Current Actions on Previously Published Items ¹

Bulletin 2025–47

1 A cumulative list of all revenue rulings, revenue procedures, Treasury decisions, etc., published in Internal Revenue Bulletins 2025–27 through 2025–52 is in Internal Revenue Bulletin 2025–52, dated December 22, 2025.

Bulletin No. 2025–47 iii November 17, 2025

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