The U.S. Centers for Medicare & Medicaid Services (CMS) on Nov. 21 moved forward with its plans to substantially expand the list of procedures outpatient surgery centers are allowed to perform.
The agency also solidified its proposal to phase out Medicare’s inpatient-only list.
Broadly, ambulatory surgery center (ASC) leaders have supported CMS’ July 2025 proposal to shift more surgical procedures away from the traditional hospital setting. While such a shift has been happening over the last several years, the now-finalized 2026 final payment rule for ASCs will add further fuel to the fire.
“Removing this [inpatient-only] list will further drive surgical volume out of the inpatient setting and into ASCs,” Joan Dentler, founder of health care advisory firm Avanza Healthcare Strategies, told ASC News in July. “It would not be surprising to see subsequent changes to Medicare and commercial reimbursement rates that continue to shift inpatient surgical volume toward surgery centers and hospital outpatient departments (HOPDs).”
In addition to expanding the ASC Covered Procedures List and phasing out the Inpatient-Only List, CMS finalized a modest payment-rate adjustment for 2026.
“For CY 2026, using the hospital market basket update, CMS finalized an update factor to the ASC rates of 2.6%,” CMS officials wrote in a fact sheet. “The update applies to ASCs meeting relevant quality reporting requirements. This update is based on the finalized IPPS market basket percentage increase of 3.3%, reduced by 0.7 percentage point for the productivity adjustment.”
The Inpatient-Only List will be phased out over three years, beginning with the removal of 285 mostly musculoskeletal services for calendar year 2026.
As a result of the final rule, hundreds of procedures will be added to the ASC mix.
“For CY 2026, we are expanding the ASC covered procedures list (CPL) by revising the criteria under § 416.166 to modify the general standard criteria and to eliminate five of the general exclusion criteria, moving them into a new section as nonbinding physician considerations for patient safety,” the more than 1,650-page final rule explained. “We also are adding 276 procedures to the ASC CPL based on these criteria changes and adding an additional 271 codes to the ASC CPL that we are finalizing for removal from the IPO list for CY 2026.”
CMS officials suggested such changes are to “give physicians greater flexibility to determine the most clinically appropriate setting for care.”
The agency also suggested the updates will allow more patients to choose outpatient surgical options while maintaining patient safety.
“We continue to advance Medicare payment reform by advancing policies that help prevent services from unnecessarily being performed in hospitals when they can be safely provided in less intensive settings, streamlining hospital billing systems, and ensuring patients receive transparent, accurate pricing information,” CMS Deputy Administrator and Director of the Center for Medicare Chris Klomp said in an announcement. “These comprehensive changes deliver greater predictability, accountability and affordability in hospital care.”
Many of the procedure codes added to the ASC-CPL are ones the Ambulatory Surgery Center Association had encouraged CMS to include.
Examples include cardiovascular codes for electrophysiology studies and ablations (93650, 93653, 93654 and 93656), plus multiple spine codes, including posterior lumbar interbody fusion (22630), and combined posterior lumbar and posterior lumbar interbody fusion (22633).
“CMS acknowledges in this rule that ASCs can provide safe care to many more beneficiaries for a much wider range of procedures than is currently available,” ASCA CEO Bill Prentice said in a final rule analysis. “While more work is needed to address structural payment issues that limit surgery centers’ ability to perform certain procedures, Medicare beneficiaries will greatly benefit from the finalized policies in this rule.”
Beyond phasing out the IPO list and adding new procedures to the ASC-CPL, CMS also listened to industry feedback in regard to removing certain measures from the ASC Quality Reporting (ASCQR) Program.
Specifically, CMS will remove measures related to staff COVID-19 vaccination coverage, screening for social determinants of health and facility commitment to health equity.
CMS also did not finalize the adoption of a measure called “Patient Understanding of Key Information Related to Recovery After a Facility-Based Outpatient Procedure or Surgery, Patent Reported Outcome-Based Performance Measure (Information Transfer PRO-PM).”
Prentice and ASCA praised CMS for not finalizing that proposed change.
“The ASC Quality Reporting Program must remain focused on measures that have been tested for validity in the surgery center setting and are directly related to safety and quality outcomes,” Prentice said in ASCA’s analysis. “Additionally, the more information surgery centers are mandated to obtain from patients, the less likely they are to get patients to respond — survey fatigue is real and CMS needs to address our concerns about the length, complexity and high cost of the OAS CAHPS Survey. The newly proposed survey on discharge instructions only added fuel to this fire, so we applaud CMS for pausing on its implementation.”
The full 2026 ASC final payment rule’s text is available here.
This is a developing story. Please revisit this page at a later time for more information.
