Executive Summary of CY 2026 Medicare Updates for ASCs

Access an executive summary of the CY 2026 Medicare updates impacting Ambulatory Surgery Centers (ASCs), physicians, specialists, and medical suppliers. This overview highlights key changes to payment policies, coverage, and quality reporting under the CMS CY 2026 Final Rule.

Key Features:

• • Payment Rate Increase: A 2.6 percent increase for ASCs that successfully meet Quality Reporting Program requirements, with a two percent reduction applied to non-compliant facilities.
  • ASC Conversion Factor: Updated CY 2026 conversion factors of $56.322 for ASCs meeting quality reporting requirements and $55.224 for those that do not.
  • Hospital Price Transparency Updates: New requirements beginning April 1, 2026, including expanded disclosure of payer-specific negotiated charges, executive attestation of accuracy, and organizational NPI reporting.
  • Two-Midnight Rule Continuation: Exemption for procedures removed from the Inpatient-Only list from certain medical review activities until outpatient billing patterns are established.
  • ASC Quality Reporting Program Changes: Removal of four quality measures and codification of the Extraordinary Circumstances Exception, including a lengthened ninety-day submission window.
  • OPPS Transitional Pass-Through Device Payments: Approval of FDA Breakthrough Devices, including VasQ™ and SCOUT MD™, for transitional pass-through payment.
  • Non-Opioid Pain Management Payments: Continued separate payment for qualifying non-opioid pain relief drugs and devices through December 21, 2027, with expanded eligible products and a new quarterly approval process.
  • Drugs and Radiopharmaceutical Updates: New add-on payment for technetium-99m derived from domestically produced molybdenum-99, including creation of new HCPCS code C9176.
  • Skin Substitute Payment Policy Changes: Separate payment finalized for certain skin substitute products, deletion of low-cost application codes, and implementation of a single per-square-centimeter payment rate.
  • Expanded ASC Procedure Coverage: Addition of 547 procedures to the ASC Covered Procedures List and beginning of phase-out of the Inpatient-Only List, supporting the shift toward outpatient care.