July 15, 2025
2026 Proposed Rule Includes Profound Changes
The Centers for Medicare & Medicaid Services (CMS) released the 2026 proposed payment rule for ASCs and hospital outpatient departments (HOPD) today. Of note, CMS proposed to vastly expand the ASC Covered Procedures List (ASC-CPL) for 2026. In addition, CMS concurred with ASCA’s request and proposed to continue to align the ASC update factor with the one used to update HOPD payments, extending the interim period an additional calendar year (CY) through 2026.
Other initial observations about the 913-page proposal follow. ASCA will provide additional analysis soon, including a rate calculator that allows users to determine what ASCs will be paid locally if the proposal is adopted.
2.4 Percent Average Rate Update
If the proposed rule is finalized as drafted, ASCs would see, on average over all covered procedures, an effective update of 2.4 percent, which is a combination of a 3.2 percent inflation update based on the hospital market basket and a productivity reduction mandated by the Affordable Care Act of 0.8 percentage points. This is an average and the updates might vary significantly by code and specialty.
The information below provides a comparison between the 2026 ASC and HOPD reimbursement proposals:
|
ASC |
HOPD |
| Inflation update factor |
3.2% |
3.2% |
| Productivity reduction mandated by the ACA |
0.8 percentage points |
0.8 percentage points |
| Effective update |
2.4% |
2.4% |
| Conversion factor |
$56.207 |
$91.747 |
Sweeping Changes to the ASC Covered Procedures List
CMS proposed to expand the ASC-CPL by revising the criteria under §416.166 to modify the general standard criteria and to eliminate five of the general exclusion criteria, moving them into a new section as nonbinding physician considerations for patient safety. Based on these criteria changes, CMS proposed to add 276 procedures to the ASC-CPL.
Many of the codes ASCA requested for inclusion are proposed for addition, including:
Cardiovascular Codes
- Electrophysiology Studies and Ablations: 93650, 93653, 93654 and 93656
- Percutaneous Coronary Intervention (PCI): C9602, C9604 and C9607
Spine Codes
- Posterior Lumbar Interbody Fusion: 22630
- Combined Posterior Lumbar and Posterior Lumbar Interbody Fusion: 22633
Vascular Code
- Vascular Embolization or Occlusion: 37244
In addition, CMS proposed a transition to eliminate the inpatient-only (IPO) list over the next few years. CMS proposed to add 271 of the codes it is removing from the IPO list in 2026 to the ASC-CPL, for a total of 547 codes proposed for addition to the ASC-CPL in 2026.
These lists of codes proposed for addition to the ASC-CPL in 2026 can be found in Table 80 and Table 81, starting on page 569 in the rule.
“The proposed expansion in surgical procedures that may be performed in ambulatory surgery centers reflects our longstanding belief that the clinical judgment of the medical community is the proper determinant for where patients can receive their care. This approach, if finalized, will allow many more Medicare beneficiaries to receive safe and effective care in surgery centers and lower costs for both patients and the Medicare program,” said ASCA Chief Executive Officer Bill Prentice.
Significant Changes to the ASC Quality Reporting Program
Regarding the ASC Quality Reporting (ASCQR) Program, CMS proposed to remove the following measures:
- ASC-20: COVID-19 Vaccination Coverage Among Health Care Personnel (HCP) beginning with the CY 2024 reporting period/CY 2026 payment determination
- ASC-22: Screening for Social Drivers of Health (SDOH) and ASC-23: Screen Positive Rate for SDOH, which were previously finalized to be mandatory with CY 2026 data collection/CY 2028 payment determinations
- ASC-24: Facility Commitment to Health Equity, which was previously finalized to be mandatory with the CY 2025 reporting period/CY 2027 payment determination
“ASCA supports meaningful quality reporting that improves transparency, safety and patient care,” said ASCA CEO Bill Prentice. “CMS correctly understood that the quality measures proposed for removal did not support this goal and instead added unnecessary burden with little benefit. We look forward to continuing work with CMS on measures that have been tested in surgery centers and will improve quality of care and patient safety.”
CMS did propose to add one new measure to the ASCQR Program, the Patient Understanding of Key Information Related to Recovery After a Facility-Based Outpatient Procedure or Surgery, Patient Reported Outcome-Based Performance Measure (Information Transfer PRO–PM), beginning with voluntary reporting for the CY 2027 and CY 2028 reporting periods followed by mandatory reporting beginning with the CY 2029 reporting period/CY 2031 payment determination.
Comments are due September 15, 2025.
ASCA members can learn more during next week’s Regulatory Series session, “Understanding Medicare’s Proposed Rule for 2026.” This session—led by ASCA Chief Advocacy Officer Kara Newbury and Associate Director of Public & Regulatory Affairs Alex Taira—will offer important insights into any new procedures added to the ASC-eligible list and any other policy changes that may impact ASC payments, including changes to the Medicare quality reporting program.
The session is scheduled for Tuesday, July 22, at 1:00 pm ET and will be available on demand afterward. It is available exclusively to ASCA members and registration is required.