Ambulatory surgery center (ASC) industry insiders are mixed when it comes to the 2025 reimbursement landscape.
ASCs typically receive reimbursement from a mix of public and private payers. Payer sources include fee-for-service Medicare and Medicare Advantage (MA), for instance, but also commercial insurance, Medicaid and self-pay.
This payer landscape has been steadily evolving in recent years, both in terms of volume and rate dynamics.
The U.S. Center for Medicare & Medicaid Services (CMS) has worked to shrink the gap between ASCs and hospital outpatient departments (HOPDs) and expanded its covered-procedures list. Meanwhile, on the commercial side, ASCs with strong outcomes and cost advantages have been able to negotiate favorable rates with their payer partners, especially for high-volume procedures.
To gain deeper insight into the latest developments and obstacles facing ambulatory surgery centers, ASC News surveyed industry professionals from a wide range of roles at the start of 2025. The group included administrators, consultants, surgeons, executive leaders and others, providing a diverse view from across the ASC landscape.
Respondents came from various types of centers, with half based in urban settings and the rest evenly split between suburban and rural locations. Half of all respondents said they worked for independent ASCs.
Additionally, 25% of participants reported performing over 10,000 cases annually, offering perspectives from some of the nation’s busiest centers.
When asked how they anticipated payer relationships evolving in 2025, nearly 44% of respondents said they believed payer-ASC relationships would remain similar compared to 2024. Just over 31% of respondents said they believed ASC-payer relationships would improve, with the remaining 25% of respondents saying they expected relationships to deteriorate.
Just 31% of surveyed individuals said they expected the vast majority of their revenue coming from private payers, including MA, in 2025. Conversely, one-quarter of respondents said they expected less than half of their revenue coming from private payers.
How do you anticipate payer relationships evolving in 2025?
Among the factors influencing ASC reimbursement dynamics in 2025 are payer consolidation and a new health care policy team under the Trump administrator. Shifting patients preferences and demand for transparent health care pricing models are also influencing reimbursement dynamics.
On the fee-for-service Medicare side, the ASC industry will have a better idea of what’s to come in the summer.
CMS normally releases the proposed payment rule for ASCs and HOPDs in late June or early July. This rule outlines proposed reimbursement changes and policy updates for the following calendar year.
