Ambulatory Surgery Centers (ASCs) continue to play a critical role in delivering efficient, high-quality care as healthcare shifts toward outpatient settings. The CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System Final Rule (CMS-1834-FC) introduces several important updates that directly affect ASC reimbursement, quality reporting, procedure coverage, and compliance requirements.
Our executive overview highlights the most impactful changes ASCs should understand as they prepare for calendar year 2026.
The CY 2026 Medicare updates impact a broad range of providers and stakeholders, including:
Understanding how these changes affect coding, billing, and operational workflows is essential to maintaining compliance and protecting revenue.
For CY 2026, Centers for Medicare and Medicaid Services finalized a 2.6 percent increase to ASC payment rates. This update reflects a projected 3.3 percent hospital market basket increase, offset by a 0.7 percent productivity adjustment.
ASCs that successfully meet quality reporting requirements will receive the full increase. Facilities that fail to meet these requirements will see a 2 percent reduction to the payment update.
The conversion factor is used to calculate payment rates for covered surgical procedures performed in ASCs.
Beginning April 1, 2026, hospitals must disclose additional payer-specific pricing data, including the 10th percentile, median, and 90th percentile allowed amounts when negotiated charges are based on percentages or algorithms. The rule also introduces a mandatory executive attestation of accuracy and requires hospitals to encode organizational NPIs.
CMS is continuing its policy exempting procedures removed from the Inpatient-Only list from certain medical review activities related to the two-midnight rule. These procedures remain protected from site-of-service claim denials and related RAC reviews until claims data shows they are more commonly billed in the outpatient setting.
ASCs must continue to participate in the ASC Quality Reporting (ASCQR) Program to receive the full payment update. Failure to comply results in a 2 percent payment reduction.
CMS finalized the removal of four measures from the ASCQR Program. These include:
CMS is formally codifying the Extraordinary Circumstances Exception policy for ASCs. This allows facilities to request relief from reporting requirements when data collection is impacted by qualifying events such as natural disasters or system failures.
Notably, the timeframe to submit an ECE request has been increased from 90 days to 60 days following a precipitating event.
CMS approved VasQ™ and SCOUT MD™ under the FDA Breakthrough Device Program, making them eligible for transitional pass-through payment under OPPS.
CMS is continuing separate payments for qualifying non-opioid pain relief treatments through December 21, 2027. For CY 2026, five drugs and thirteen devices qualify for separate payment.
CMS will now evaluate new products quarterly rather than annually, with payments applied retroactively to the date eligibility criteria are met. ASCs should monitor approvals closely to avoid missed reimbursement opportunities.
For CY 2026, CMS finalized a $10 per-dose add-on payment for radiopharmaceuticals using technetium-99m derived from domestically produced molybdenum-99, with a new HCPCS code C9176 and a requirement that at least fifty percent of the source material be domestically produced.
CMS finalized significant changes to skin substitute payment policy, including:
These changes are intended to improve billing accuracy and payment transparency.
CMS has initiated a phased elimination of the Inpatient-Only List, with all codes scheduled for removal by January 1, 2029. For CY 2026, 285 procedures, largely musculoskeletal, are being removed from the list and assigned to appropriate APCs.
CMS is adding 547 procedures to the ASC Covered Procedures List for 2026. This expansion reflects revised regulatory criteria and aligns with the broader transition away from inpatient-only designations.
The CY 2026 Medicare updates present both opportunities and compliance considerations for Ambulatory Surgery Centers. Staying informed, validating coding and billing workflows, and proactively adjusting operational processes will be key to navigating these changes successfully.
For a deeper dive into the CY 2026 updates and what they mean for your ASC, download our Executive Summary – An Overview of Medicare Updates for Ambulatory Surgery Centers in CY 2026.
Since 1992, HIA has been the leading provider of compliance audits, coding support services and clinical documentation audit services for hospitals, ambulatory surgery centers, physician groups and other healthcare entities. HIA offers PRN support as well as total outsource support.
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.