Medicare’s ASC Proposals for CY 2026

On July 15, 2025, the Centers for Medicare & Medicaid Services (“CMS”) issued the CY 2026 Hospital Outpatient Prospective Payment System (“OPPS”) and Ambulatory Surgical Center (“ASC”) Payment System proposed rule. The rule, as drafted, proposes updating the payment rates of both OPPS hospital rates and ASC rates by 2.4%, calculated via the respective market basket percentage increases of 3.2% and reduced productivity adjustment of 0.8 percentage points. Regarding the ASC Covered Procedures List (“ASC-CPL”), the CY 2026 proposed rule is looking to make significant additions to the ASC-CPL, similar to the CY 2021 OPPS/ASC final rule, as explained below.

History of Added Procedures to the ASC-CPL and Exclusion Criteria

The CY 2021 OPPS/ASC final rule made significant changes to both the ASC-CPL and the criteria for adding procedures to the list. That rule added 267 surgical procedures to the ASC-CPL, and CMS began to further emphasize the judgment of physicians as to which procedures would be covered by Medicare when performed in an ASC. The CY 2021 rule changed the criteria that was previously used to add procedures to the ASC-CPL into situation-specific factors for physicians to consider in deciding whether an individual should receive coverage for that particular procedure.

Then the CY 2022 rule significantly departed from the CY 2021 rule. The CY 2022 rule not only reversed the criteria changes made in CY 2021 by reinstating the CY 2020 criteria for adding procedures, but it also removed 255 of the 267 surgical procedures added just the year before. The CY 2022 rule did, however, begin a “nomination process,” through which third parties could suggest surgical procedures they believed both met the applicable criteria and should be added to the ASC-CPL list.

Overview of Proposed Added Procedures to the ASC-CPL

The CY 2026 proposed rule seems to mirror the trend of the CY 2021 rule in both the proposed additions to the ASC-CPL and the criteria for adding new procedures. The proposed rule suggests adding 276 surgical procedures to the ASC-CPL and transferring 271 codes from the Inpatient Only Procedures List to the ASC-CPL, resulting in a total addition of 547 codes. Many of the additions are cardiovascular, vascular and spine codes that were previously added then removed between the CY 2021 and CY 2022 final rules. Examples of the added procedures include: electrophysiology studies and ablations (93650, 93653, 93654, 93656); percutaneous coronary intervention (C9602, C9604, C9607); vascular embolization or occlusion (37244); posterior lumbar interbody fusion (22630); and combined posterior lumbar and posterior lumbar interbody fusion (22633). A complete list of proposed added codes can be found in Tables 80 and 81 of the rule.

Similar to the CY 2021 rule, CMS has proposed to again change the criteria for adding new procedures and codes to the ASC-CPL. The CY 2026 rule proposes transforming five existing exclusion criteria into “nonbinding physician considerations,” giving more deference to the personal judgment of physicians.

Additions to the ASC-CPL generally reflect both CMS’s, physicians’ and the public’s beliefs about which procedures can be safely, effectively and efficiently performed in ASC settings. The proposed changes in the CY 2026 proposed rule seem to signal that both CMS and the public are looking to increase accessibility to surgical procedures in the lowest cost setting possible, while still prioritizing patient safety. The CY 2026 proposed rule is not only looking to greatly increase the number of procedures provided in ASCs through the proposed additions to the ASC-CPL, but is also looking to provide physicians with more say as to the procedures they believe can be performed safely and efficiently in ASCs.

For more information on the CY 2026 proposed rule as it relates to telehealth, see our previous publication on Medicare’s Telehealth Proposals for CY 2026.

Practical Takeaways

• The expansion of the ASC-CPL supports the trend of transitioning as many procedures as can be performed safely in an ASC from the hospital setting, a trend which is overwhelmingly supported by surgeons, payors and most importantly, patients.
• Stakeholders should consider submitting comments on the proposed changes before September 15, 2025, using code CMS-1834-P.
• Consider when structuring ASC arrangements, whether the addition of the new procedures may affect physicians eligible to invest in the ASC.
• Consider how the proposed added procedures may affect your current system and plan for addressing these changes if the CY 2026 final rule mirrors that of the proposed rule.

If you have any questions or would like additional information about this topic, please contact:

• Katie Miller at (317) 977-1404 or kmiller@hallrender.com;
• Jennifer Struck at (317) 429-3674 or jstruck@hallrender.com; or
• Your primary Hall Render contact.

Special thanks to Summer Associate Eleanor Hagenow for her assistance in the preparation of this article.