The Ambulatory Surgery Center Association (ASCA) is calling on federal regulators to help support surgery centers across the U.S.
In a Feb. 19 letter to the U.S. Centers for Medicare & Medicaid Services (CMS), ASCA laid out a series of recommendations aimed at bolstering ambulatory surgery center (ASC) payments while also expanding the number of procedures eligible for ASC reimbursement. The industry group also asked CMS to consider recalibrating quality reporting measures.
These proposals come ahead of the 2026 Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System rule making cycle.
At the heart of ASCA’s appeal is a request that CMS should continue use of the hospital market basket as the annual update mechanism for ASC payments, which the association said would ensure ongoing alignment between ASC and hospital outpatient department (HOPD) payment updates.
ASCA said that this alignment, adopted during the first Trump administration, has helped drive more surgical volume from higher-cost HOPDs to lower-cost ASCs.
“ASCs already save Medicare more than $5.3 billion annually simply by existing as an alternative to hospitals,” ASCA wrote. “CMS should adopt policies that encourage the migration of more procedures to the surgery center setting to generate even greater savings.”
Removal of the ASC weight scalar
In its letter, ASCA said that CMS should discontinue the ASC weight scalar, which CMS originally instituted to achieve budget neutrality.
“When CMS aligned the ASC and HOPD update factors under the first Trump administration in 2019, it became even clearer that this secondary scaling adjustment must be eliminated to truly align the payment systems and motivate increased migration of surgery to the ASC setting,” ASCA wrote.
ASCA said the scalar is a “secondary scaling adjustment” that has outlived its original intent, claiming that current policies “penalize migration to a lower-cost setting” and fail to recognize the high-quality, cost-effective care that ASCs provide.
“The agency has recklessly continued the scalar after the initial year of the new ASC payment system pursuant to its own perceived authority, and not any identified statutory requirement,” ASCA wrote. “This administration has clear legal authority to discontinue the scalar at its discretion. ASCA implores CMS to generate additional savings and greater access to surgery centers for Medicare beneficiaries by eliminating the ASC weight scalar.”
Expansion of the ASC Covered Procedures List (ASC-CPL)
Another topic was the addition of new procedures to the ASC-CPL.
Heading into 2025, ASCA and several ASC leaders expressed frustration with CMS declining to add several procedures for coverage during the agency’s 2024 rulemaking cycle. CMS asked for industry feedback, but then did not address that feedback in a clear and transparent manner, critics of CMS believe.
ASCA said it wants to see a more robust and explicit CMS rationale whenever a procedure is not approved.
“We were extremely disappointed that in 2025 rulemaking, CMS did not add any of the codes requested by ASCA and its physicians,” ASCA wrote. “CMS grouped requests by specialty and provided vague assertions questioning the safety of the procedures without citing any research or data.”
Among specific requests, ASCA urged CMS to add CPT Codes 22630 and 22633 (both lumbar interbody fusion procedures) to the ASC-CPL. ASCA also noted that cardiology services, like cardiac ablation codes, are safe and cost effective in the ASC setting.
“Recent data presented to CMS by the Heart Rhythm Society (HRS) supports the continued expansion of the ASC-CPL with cardiology codes, especially cardiac ablation codes,” ASCA wrote.
The potential to perform ablations in the ASC setting has piqued the interest of larger operators recently, like Altas Healthcare Partners and MedAxiom.
“Heart ablations for electrophysiological disorders like arrhythmias and atrial fibrillation are being adopted more and more under private payer contracts,” Joe Sasson, chief commercial officer and senior vice president of Ventures at MedAxiom, told Ambulatory Surgery Center News recently. “Hopefully, those will be reimbursed by CMS and others, starting in ’26 or maybe ’27. We hope for ’26.”
Reevaluation of the ASC Quality Reporting Program
While ASCA said it is committed to a robust quality reporting program, the association voiced concerns about the current ASC Quality Reporting Program (ASCQR).
Certain measures, especially those added recently, will create excessive administrative burdens for ASCs without yielding clear benefits to patients, ASCA wrote. The organization specifically called for the removal of ASC-20 (COVID-19 Vaccination Coverage Among HCP).
“As ASCA feared when this measure was first proposed back in 2022 rulemaking, the measure has placed an undue burden on our facilities and the implementation has been confusing, with definitions constantly changing midstream,” ASCA wrote.
ASCA also requested that CMS delay inclusion of new health equity measures (ASC-22 through ASC-24) until they have been properly tested in the ASC environment.
“ASCA supports access to care for all patients,” they wrote. “However, 2025 rulemaking was unclear as to how the following measures will address the disparities that exist or how CMS will support the facilities required to collect this information.”
