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ASCA Submits Comments on CMS’ 2026 Proposed Payment Rule

Key focus areas include codes added to the ASC-CPL, the annual payment update mechanism and the ASCQR Program

BY KARA NEWBURY | SEPTEMBER 18, 2025

Earlier this week, ASCA submitted formal comments in response to the Centers for Medicare & Medicaid Services’ (CMS) 2026 proposed payment rule for ASCs and hospital outpatient departments (HOPD).

In its comments, ASCA supported CMS’ proposal to broadly expand the list of procedures allowed to be performed in ASCs. In the proposed rule released on July 15, CMS suggested adding 276 procedures to the ASC Covered Procedures List (ASC-CPL) that are currently payable in the HOPD setting. ASCA agrees with CMS that clinicians are the stakeholders best suited to determine the appropriate site of service for their patients. In addition, CMS proposed a transition to eliminate the inpatient-only (IPO) list over the next few years. The agency suggested adding 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. ASCA supported this proposal in theory but expressed concerns about implementation.

ASCA also requested that CMS add the cardiology codes that it already submitted for addition through the ASC CPL Pre-Proposed Rule Recommendation Request: Electrophysiology Studies and Ablations, 93619, 93620 and 93642; and Cardioversion and Transesophageal Echocardiogram (TEE), 92960, 93312 and 93318.

In the comments, ASCA urged CMS to continue to use the hospital market basket as the annual update mechanism for ASC payments to ensure better alignment with the HOPD payment system. In the proposed rule, CMS extended the alignment period an additional calendar year through 2026. After the first Trump administration piloted the use of the hospital market basket for ASCs beginning in 2019, there were promising signs of migration from the higher-cost HOPD setting to ASCs. Further research is needed, but when analyzing surgical volume across three outpatient settings—HOPDs, ASCs and physician offices—ASCs increased their fee-for-service (FFS) market share 0.3 percent between 2021 and 2023, while at the same time HOPD volume declined a commensurate 0.3 percent.

In addition, ASCA asked CMS to discontinue the ASC weight scalar. Lack of alignment for the ASC (secondary) weight scalar threatens outpatient access to care and stifles the ability of surgery centers to perform all the Medicare cases that potentially could be absorbed. The positive impact of the conversion factor alignment is negated by the application of a secondary weight scalar to the ASC payment system. The savings that ASCs generate for the Medicare program will remain limited until this oversight is rectified.

With regards to quality reporting, ASCA supported CMS’ proposal to remove four measures—ASC-20, ASC-22, ASC-23 and ASC-24—from the ASC Quality Reporting (ASCQR) Program. ASCA supports meaningful quality reporting that can improve transparency and patient care. However, those four measures proposed for removal hold little applicability to meaningful measurement of a surgery center’s operational quality.

ASCA also raised concerns about the low response rates of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey, and requested that ASCs not be penalized for 2027 even if they fail to meet the required 200 completed surveys. This patient experience survey became a mandatory component of the ASCQR Program on January 1, 2025. This unfunded mandate is costing ASCs thousands of dollars a year and supplants much less-expensive patient satisfaction surveys that produced much higher return rates.

ASCA also responded to CMS’ “Request for Information (RFI): Adjusting Payment Under the OPPS for Services Predominately Performed in the Ambulatory Surgical Center or Physician Office Settings,” an RFI examining site-neutral options. On its face, the phrase “site neutrality” has been construed as a catch-all to include policy proposals that the ASC community of healthcare providers and patients could support. However, ASCA has concerns that congressional proposals to date focus only on the cost of care and do not contemplate unintended clinical impacts that could limit access to care.

In its comments, ASCA strongly recommended that the agency extensively research the ramifications of site neutrality on access to care and safety concerns before implementing any policies.

Write Kara Newbury at knewbury@ascassociation.org with any questions.