Looking For CMS 2026 ASC Payment Rule Updates? Here Are 10 Things You Should Know
- mensahstacy0
- 4 days ago
- 4 min read
The Centers for Medicare & Medicaid Services (CMS) finalized the 2026 Ambulatory Surgery Center (ASC) Payment System rule. Major changes ahead. ASC administrators and compliance leads: here's what to know.
Disclaimer: This content is for informational purposes only. It does not constitute legal, financial, or regulatory advice. Consult qualified professionals for guidance specific to your facility.
1. Average 2.6% Payment Increase
CMS approved an average effective payment update of 2.6% across all covered ASC procedures for calendar year 2026.
Breakdown:
3.3% hospital market basket inflation update
Minus 0.7 percentage point productivity adjustment
Net: 2.6% increase
This rate aligns with the hospital outpatient department (HOPD) update factor. CMS extended the HOPD-ASC alignment through 2026 following advocacy from the Ambulatory Surgery Center Association.
Operational impact: Budget planning for 2026 should factor in this increase. However, individual procedure codes will vary significantly from this average.
2. Largest Expansion of Covered Procedures in Years
CMS finalized its most significant expansion of the ASC Covered Procedures List (ASC-CPL) in recent memory.
Total new codes added: 573
This expansion opens substantial new revenue opportunities for ASCs equipped to handle additional procedure types. Facilities should evaluate which newly covered procedures align with their capabilities, staffing, and equipment.
3. 302 Procedures Added Through Revised Criteria
CMS modified the general standard criteria under §416.166.
Key change: Five general exclusion criteria were eliminated. These criteria are now converted to nonbinding physician considerations rather than absolute exclusions.
Result: 302 new procedures now qualify for the ASC-CPL based on these revised standards.
Action step: Review the updated criteria language. Assess whether previously excluded procedures at your facility now qualify under the new framework.
4. 271 Codes Transitioned from Inpatient-Only List
CMS is initiating a multi-year transition to eliminate the inpatient-only (IPO) list.
For 2026: 271 codes from the IPO list are being added directly to the ASC-CPL.
This shift reflects CMS's recognition that advances in surgical techniques, anesthesia, and post-operative care protocols now allow many procedures to be performed safely in outpatient settings.
Compliance note: Facilities considering these newly eligible procedures must ensure appropriate patient selection criteria, emergency transfer agreements, and clinical protocols are in place.
5. Cardiovascular, Spine, and Vascular Codes Now Included
Among the newly added procedures:
Cardiovascular codes
Spine codes
Vascular codes
These specialty areas were specifically requested by ASCs for inclusion in the covered procedures list.
Strategic consideration: Facilities with existing cardiovascular, orthopedic, or vascular programs should review the specific codes added. New service line development may be feasible for facilities with appropriate infrastructure.
Risk management reminder: Higher-acuity procedures require enhanced emergency preparedness, staff competencies, and transfer protocols. Consider a risk management training review before expanding services.
6. Ophthalmic Procedures: Significant Correction Applied
CMS corrected a calculation error from the proposed rule affecting cataract and other ophthalmic codes.
Original proposal: 4.7% decrease for ophthalmology procedures
Final rule: 3.4% increase
This correction is substantial for ASCs with high ophthalmology procedure volumes. Budget projections based on the proposed rule should be revised accordingly.
7. HOPD Update Factor Alignment Extended
CMS agreed to extend the interim period aligning the ASC update factor with the HOPD update factor through calendar year 2026.
Background: Historically, ASC payment updates lagged behind HOPD updates. This alignment ensures payment parity during the interim period while CMS continues evaluating long-term payment methodology.
What this means: ASCs receive the same percentage update as hospital outpatient departments for 2026. Monitor CMS communications for potential changes in future years.
8. Quality Reporting Requirements Remain in Effect
Quality reporting obligations continue unchanged.
Penalty for non-compliance: ASCs failing to meet quality reporting program requirements face a 2.0 percentage point reduction in payments for all applicable services.
Quality measures to track:
Patient burn rates
Patient fall rates
Wrong site/side/patient/procedure events
Hospital transfer/admission rates
ASC facility volume data on selected procedures
Action step: Audit your current quality reporting processes. Ensure data submission deadlines are met. Consider an initial consultation to identify compliance gaps before they impact reimbursement.
9. Code-by-Code Updates Vary Significantly
The 2.6% average masks considerable variation at the individual code level.
Important: Some procedure codes will see increases above 2.6%. Others may see minimal increases or even decreases depending on:
Relative value adjustments
Practice expense recalculations
Specialty-specific factors
Operational impact: Revenue cycle teams should obtain the complete fee schedule once published. Map high-volume procedures at your facility against specific code updates. Adjust financial projections accordingly.
10. Total Medicare ASC Reimbursement Projected at $9.2 Billion
CMS estimates total payments to ASC providers for 2026 will reach approximately $9.2 billion.
Year-over-year increase: Approximately $450 million from 2025 levels.
This growth reflects both the payment rate increase and expanded procedure coverage. ASCs positioned to capture newly covered procedures may see above-average revenue growth.
Summary: Key Action Items for ASC Administrators
Area | Action Required |
Financial planning | Update 2026 budgets with 2.6% average increase; review code-specific rates |
Service line expansion | Evaluate 573 new covered procedures for strategic fit |
Clinical protocols | Develop/update protocols for higher-acuity procedures |
Quality reporting | Audit compliance; avoid 2.0 percentage point penalty |
Staff training | Ensure competencies align with new procedure offerings |
Emergency preparedness | Review transfer agreements and emergency protocols |
Preparing Your Facility for 2026
The 2026 CMS rule presents both opportunities and compliance obligations. Expanded procedure coverage creates revenue potential. Payment increases support operational sustainability. Quality reporting requirements demand ongoing vigilance.
Recommended preparation steps:
Download the final rule and addenda from CMS.gov
Conduct a gap analysis against newly covered procedures
Review credentialing requirements for expanded services
Update infection control protocols for new procedure types: consider infection control annual training
Schedule a facility mock survey to assess survey readiness
Brief governing body and medical staff leadership
Need Support Navigating These Changes?
The Mensah Group LLC provides healthcare consulting services for ambulatory surgery centers navigating regulatory updates, survey preparation, and operational compliance.
Services include:
Mock surveys and survey readiness assessments
Policy and procedure development
QAPI program support
Infection control and emergency management planning
Staff training programs
Contact us to schedule a consultation. Visit The Mensah Group LLC to learn more about our ASC-focused services.
This article is intended for educational purposes. Regulatory requirements may change. Always verify current CMS guidance and consult with qualified healthcare compliance professionals before making operational decisions.
Comments