The Medicare Payment Advisory Commission (MedPAC) is again urging Congress to require ambulatory surgery centers (ASCs) to report cost data to Medicare.
Broadly, the commission’s 17 members – who are appointed to three-year terms – argue that policymakers lack visibility into the sector’s financial performance as spending continues to grow. That trend is likely to continue as well, driven by patient, payer and physician preferences for the outpatient setting.
In its March 2026 report to Congress on Medicare payment policy, MedPAC emphasized that the absence of cost reporting from ASCs stands out compared with other provider types that participate in Medicare.
“But policymakers know little about the costs that ASCs incur in treating beneficiaries because Medicare does not require ASCs to submit cost data, unlike its requirements for other types of facilities,” MedPAC wrote.
The commission has repeatedly called for such reporting over the past decade (every year since 2010, in fact), contending that more detailed financial data would help ensure Medicare payment rates accurately reflect the cost of delivering care.
“The Commission contends that ASCs could feasibly provide cost data and for many years has recommended that the Congress require ASCs to submit such data,” MedPAC noted.
Currently, payment rates for ASC services are largely derived from hospital outpatient department (HOPD) data rather than direct information from the facilities themselves, according to MedPAC. The commission believes that structure means policymakers cannot easily determine whether payments for specific procedures exceed – or fall short of – the costs ASCs incur.
“Cost data would enable policymakers to establish payment rates that accurately reflect ASC costs,” MedPAC continued.
Better data could also help policymakers assess whether the payment system creates incentives for ASCs to focus primarily on the most profitable procedures, MedPAC added.
In 2024, fee-for-service Medicare payments and beneficiary cost sharing for ASC services totaled about $7.5 billion, reflecting steady growth in procedure volume and the addition of more complex surgeries to the outpatient setting.
“To the extent that there is a difference in the cost structures of HOPDs and ASCs, ASC payment rates do not accurately reflect the cost of ASCs,” MedPAC stated. “Though some evidence suggests that FFS Medicare’s payments for ASC services are higher than ASC costs on average, it is plausible that ASC payment rates are higher than ASC costs for some services and lower than ASC costs for others.”
“This disparity would create incentives for ASCs to focus on providing high-margin services, which would narrow their scope of services relative to what they might offer if the payment rate for each service accurately reflected ASC costs,” the commission continued.
For context, hospitals, skilled nursing facilities (SNFs), home health agencies, inpatient rehab facilities (IRFs) and several other Medicare-provider types submit cost data. Generally, these types of reports include information on operating costs, revenue sources, utilization metrics and more.
It isn’t just ASCs that don’t submit cost data, however. Independent diagnostic testing facilities (IDTFs) also do not, for instance.
