November 21, 2025
Alexandria, VA—Today, the Centers for Medicare & Medicaid Services (CMS) released the 2026 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule. The Ambulatory Surgery Center Association (ASCA) supports key policy updates in the rule that will enhance beneficiary access to vital surgical services, lower costs for patients and reduce long-term spending for the Medicare program.
“CMS acknowledges in this rule that ASCs can provide safe care to many more beneficiaries for a much wider range of procedures than is currently available,” said Bill Prentice, ASCA chief executive officer. “While more work is needed to address structural payment issues that limit surgery centers’ ability to perform certain procedures, Medicare beneficiaries will greatly benefit from the finalized policies in this rule.”
Of note, CMS finalized a policy that will change the general procedure criteria in the Code of Federal Regulations and create new language that places greater emphasis on clinician consideration in determining the appropriate site of service for patients. The change in regulatory language will add 289 procedures to the ASC Covered Procedures List (ASC-CPL), effective January 1, 2026. CMS also finalized a phased elimination of the inpatient-only (IPO) list and will add 271 codes from the IPO list to the ASC-CPL, creating a total of 560 new codes reimbursable in surgery centers. Other notable policy changes include:
- An effective inflationary rate update of 2.6 percent, which is a combination of a 3.3 percent inflation update based on the hospital market basket and a productivity reduction mandated by the Affordable Care Act of 0.7 percentage points.
- A one-year extension of the use of the hospital market basket (HMB) inflationary update factor, rather than the Consumer Price Index for All Urban Consumers (CPI-U), which was used prior to 2019.
- The removal of four measures from the ASC Quality Reporting (ASCQR) Program, in line with ASCA requests:
- ASC-20: COVID-19 Vaccination Coverage Among Health Care Personnel (HCP);
- ASC-22: Screening for Social Drivers of Health (SDOH);
- ASC-23: Screen Positive Rate for SDOH; and
- ASC-24: Facility Commitment to Health Equity.
- The refusal to add the Information Transfer PRO-PM (patient-reported outcome-based performance measure) to the ASCQR Program in line with ASCA’s recommendation.
“The ASC Quality Reporting Program must remain focused on measures that have been tested for validity in the surgery center setting and are directly related to safety and quality outcomes,” Prentice said. “We are grateful that CMS considered industry comments and acknowledges patient survey fatigue that affects the quality and quantity of responses. We look forward to continuing to work with CMS on measures that can accurately reflect the high quality of care provided in surgery centers.”
Read the CMS final rule fact sheet and the 1,657-page final rule.