July 15, 2025
Alexandria, VA—The Centers for Medicare & Medicaid Services (CMS) released the 2026 proposed payment rule for ASCs and hospital outpatient departments (HOPD) today. The agency proposed a transition to eliminate the inpatient-only (IPO) list over the next few years and add 271 of the codes it is removing from the IPO list to the ASC Covered Procedures List (ASC-CPL) for a total of 547 codes. 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.
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 proposed productivity adjustment of 0.8 percentage points. This is an average and the updates might vary significantly by code and specialty.
The 276 procedures that the agency proposed to add to the ASC-CPL based on the revised criteria include many of the codes that ASCA requested to add, 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
The 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,” said ASCA Chief Executive Officer Bill Prentice. “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.”
In the ASC Quality Reporting (ASCQR) Program, CMS proposed to remove all three measures that ASCA requested it to remove: 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; and 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,” Prentice said. “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.
Read the 913-page proposal.