November 21, 2025
2026 Final Payment Rule Includes Profound Procedure List Changes
The Centers for Medicare & Medicaid Services (CMS) released the 2026 final payment rule for ASCs and hospital outpatient departments (HOPD) today. Of note, CMS vastly expanded the ASC Covered Procedures List (ASC-CPL) for 2026. In addition, CMS concurred with ASCA’s request 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.
CMS did acknowledge an error in calculations that negatively impacted rates for cataract surgeries, especially CPT 66984. Instead of a 4.7 percent cut as proposed, the rate for CPT 66984 will actually increase approximately 3.4 percent from 2025 rates.
Other initial observations about the 1,657-page rule follow. ASCA will provide additional analysis soon, including a rate calculator that allows users to determine what ASCs will be paid locally.
2.6 Percent Average Rate Update
ASCs will see, on average over all covered procedures, an effective 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 adjustment of 0.7 percentage points. This is an average and the updates might vary significantly by code and specialty.
The information below provides a comparison between 2026 ASC and HOPD reimbursement:
|
ASC |
HOPD |
| Inflation update factor |
3.3% |
3.3% |
| Productivity reduction mandated by the ACA |
0.7 percentage points |
0.7 percentage points |
| Effective update |
2.6% |
2.6% |
| Conversion factor |
$56.322 |
$91.415 |
Sweeping Changes to the ASC Covered Procedures List
CMS finalized its proposal 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 will add 276 procedures to the ASC-CPL.
Many of the codes ASCA requested for inclusion will be added to the ASC-CPL, 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 Codes
- Vascular Embolization or Occlusion: 37244
In addition, CMS finalized its proposal to start the transition of eliminating the inpatient-only (IPO) list over the next few years. CMS will add 271 of the codes it is removing from the IPO list in 2026 to the ASC-CPL, for a total of 547 codes finalized for addition to the ASC-CPL in 2026.
The lists of codes finalized for addition to the ASC-CPL in 2026 can be found in Table 131 and Table 132, starting on page 1,068 in the rule.
“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.”
Significant Changes to the ASC Quality Reporting Program
Regarding the ASC Quality Reporting (ASCQR) Program, CMS finalized its proposal to remove the following measures:
(1) ASC-20: COVID-19 Vaccination Coverage Among Health Care Personnel (HCP) beginning with the CY 2024 reporting period/CY 2026 payment determination
(2) 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
(3) ASC-24: Facility Commitment to Health Equity, which was previously finalized to be mandatory with CY 2025 reporting period/CY 2027 payment determination
Also, although proposed, CMS decided not to finalize the adoption of 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) at this time. ASCA advocated against its addition to the ASCQR Program.
“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. “Additionally, the more information surgery centers are mandated to obtain from patients, the less likely they are to get patients to respond—survey fatigue is real and CMS needs to address our concerns about the length, complexity and high cost of the OAS CAHPS survey. The newly proposed survey on discharge instructions only added fuel to this fire, so we applaud CMS for pausing on its implementation.”
ASCA staff will continue to analyze the rule in detail and provide more information to help ASC operators understand the impact of the rule on their centers.
ASCA members can learn more about the final rule at next month’s webinar, “2026 Final Payment Rule.” This session, led by ASCA Chief Advocacy Officer Kara Newbury, will offer important insights into the procedures added to the ASC-CPL, changes to the ASCQR Program and much more.
The session is scheduled for Tuesday, December 2, at 1:00 pm ET and will be available on demand afterward.