CMS Releases 2027 Proposed Payment Rule

July 2, 2026

The Centers for Medicare & Medicaid Services (CMS) released the 2027 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 2027. 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 through 2027.

Other initial observations about the 723-page rule 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% 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%, which is a combination of a 3.2% 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 2027 ASC and HOPD reimbursement proposals:

“We are gratified that CMS is proposing to keep ASC inflationary updates aligned with those of the hospital outpatient departments by use of the hospital market basket index,” said ASCA President Todd Currier. “However, other payment policies will disincentivize ASCs from providing care to Medicare beneficiaries. For example, despite the inflation update, this proposal would actually reduce payments for the most common procedures that ASCs perform.”

For 2027, all of the top 10 codes by volume are projected to see a decrease in reimbursement from 2026 rates. The table below shows the current reimbursement rates, the 2027 proposed rates found in the ASC addenda and the delta between those rates for the top 10 ASC codes by volume.

Significant Changes to the ASC Covered Procedures List

CMS plans to widely expand the ASC-CPL in 2027, proposing 618 codes for addition.

Many of these codes, including all four of the hernia codes ASCA requested for inclusion, are procedures also proposed for removal from the inpatient-only (IPO) list for 2027. CMS proposes removing a total of 637 procedures from the IPO list in 2027, continuing its transition to phase out the IPO list entirely.

“CMS’ proposal to continue to eliminate the in-patient only procedure list will allow the clinical judgment of surgeons to determine where care can be best provided,” said ASCA CEO Bill Prentice. “While the great majority of these procedures will still be performed in the hospital for the foreseeable future, this change will spark advancements in clinical care that will lead to more procedures being available to patients in the more affordable and convenient outpatient setting.”

Changes to the ASC Quality Reporting Program

Regarding the ASC Quality Reporting (ASCQR) Program, CMS proposed to remove ASC-9: Endoscopy/Polyp Surveillance: Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients.

CMS did not propose to add any new measures to the ASCQR Program.

“Beyond the continued elimination of the inpatient-only list, this rule proposal largely maintains the status quo in terms of ASC policy,” said Prentice. “We implore CMS leaders to work with us to generate policies that use the ASC model to provide more care to Medicare beneficiaries and in so doing save the program billions of dollars yearly. A recent study that ASCA commissioned by KNG Health Consulting showed that ASCs will generate more than $84 billion in savings to the Medicare program over the next 10 years because we exist as a lower-cost site of service. Imagine how many more billions of dollars could be freed up if surgery centers were incented to provide more care to the beneficiaries who require outpatient care.”

Comments are due August 31, 2026.

ASCA members can learn more during next month’s Regulatory Series session, “Understanding Medicare’s Proposed Rule for 2027.” This session—led by ASCA Chief Advocacy Officer Kara Newbury and ASCA Associate Director of Public & Regulatory Affairs Alex Taira—will offer important insights into new procedures added to the ASC-CPL and any other policy changes that may impact ASC payments, including changes to the ASCQR Program.

The session is scheduled for Tuesday, August 4, at 1:00 p.m. ET and will be available on demand afterward. It is available exclusively to ASCA members and registration is required.