The U.S. Centers for Medicare & Medicaid Services (CMS) is delaying the implementation of its five-year prior-authorization demonstration for ambulatory surgery centers (ASCs). Originally, the prior-auth demo was set to go live in December 2025 across all participating states: California, Florida, Texas, Arizona, Ohio, Tennessee, Pennsylvania, Maryland, Georgia and New York. Now, the demo will be rolled out in two phases. ASCs in California, Florida, Tennessee, Pennsylvania, Maryland, … [Read more...]
[Updated] Citing Need to Stop Services from ‘Unnecessarily Being Performed in Hospitals,’ CMS Finalizes Expansion of ASC-Covered Procedures
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 … [Read more...]
Rural ASCs Battle Persistent Pain Points, But Federal Investment Could Spur New Opportunities
Opening an ambulatory surgery center (ASC) in a rural area means significant challenges, including a shortage of skilled health care staff, geographic isolation and a smaller patient base, all of which can make it difficult to achieve high surgical volumes and maintain profitability. Other obstacles include poor infrastructure, limited access to reliable transportation and supply chain issues that can increase operational costs. “There has not been much new development in rural health … [Read more...]
Medicare Finalizes 2026 Physician Payment Rule, New Ambulatory Specialty Model: Top Takeaways for ASCs
The Centers for Medicare & Medicaid Services (CMS) has released the 2026 Medicare Physician Fee Schedule (PFS) final rule, which, as always, has a few key takeaways for ambulatory surgery centers (ASCs). The agency says the rule is focused on modernizing payment accuracy by finalizing an “efficiency adjustment” for select services and a one-time 2.5% increase in physician payments. “CMS is working to strengthen and transform Medicare for current and future generations while cracking … [Read more...]
The Future of ASCs Looks Promising as Payers Seek Cost-Efficiencies
The future looks promising for ambulatory surgery centers (ASCs) as the health care industry’s focus on cost efficiencies shifts toward where surgical procedures are performed. Surgeries with increasing complexity, once limited to hospitals, are now shifting to ASCs, indicating continued growth for the foreseeable future. A recent Jefferies equity research report highlighted the structural tailwinds driving this transformation and projected 6% to 8% growth for the ASC sector through … [Read more...]
CMS Clarifies Survey, Certification Procedures During Government Shutdown
The U.S. Centers for Medicare & Medicaid Services (CMS) has clarified its position on survey and credentialing activities during the government shutdown. In a Tuesday memo, the agency effectively limited survey work during the federal shutdown to essential health and safety functions. For ambulatory surgery centers (ASCs), only complaint investigations classified as immediate jeopardy (IJ)and those involving actual harm may proceed, along with revisits approved by exception and … [Read more...]
Inpatient-Only List Overhaul Could Put Pressure on ASC, Post-Acute Care Coordination
A proposal from the Centers for Medicare & Medicaid Services (CMS) to phase out Medicare’s Inpatient-Only List (IPO) while adding more procedures for ambulatory surgery centers (ASCs) is stirring debate over how patients move through the continuum of care. As surgical capabilities advance, more complex procedures can safely take place outside of hospitals, including in ASCs. In turn, CMS in its 2026 proposed payment rule for ASCs has suggested phasing out the IPO list over three years, … [Read more...]
New HHS Health Care Advisory Committee Gives ASCs a Platform to Showcase Their Strategic Value
The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) are launching a health care advisory committee, giving surgery centers a new platform to showcase their strategic value. Moving forward, the committee will deliver recommendations directly to HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz. Specifically, the committee will be tasked with advising on how care is financed and delivered across Medicare, … [Read more...]
[Updated] CMS Proposes Eliminating the Inpatient Only List, 2.4% ASC Payment Rate Update for 2026
The U.S. Centers for Medicare & Medicaid Services (CMS) is calling for big changes to how – and where – surgical procedures are performed. Specifically, federal regulators are pushing to eliminate the Medicare Inpatient Only List (IPO) while significantly expanding the ASC Covered Procedures List (ASC-CPL). The agency floated those plans on July 15 when it released its 2026 ASC payment system proposed rule. While there’s much to unpack in the more than 900-page proposed rule, such … [Read more...]
CMS Proposes 3.6% Physician Reimbursement Increase, Announces New Ambulatory Payment Model
The U.S. Centers for Medicare & Medicaid Services (CMS) released its proposed physician fee schedule for 2026 on July 14, along with a flurry of potential changes, including a new payment model for specialty ambulatory services. Beginning in 2026, there will be two separate conversion factors that CMS uses in its calculations. One will be for qualifying alternative payment model (APM) participations, while the second will be for physicians and practitioners who don’t fall into that … [Read more...]