CMS releases 2027 proposed payment rule for ASCs and HOPDs; ASCA responds

The Centers for Medicare & Medicaid Services (CMS) last week released the 2027 proposed payment rule for ASCs and hospital outpatient departments (HOPDs). You can access and download a PDF of the full 723-page rule here.

In addition to issuing a press release headlined “CMS Disincentivizes Procedure Migration with Decline in Many Payment Rates,” the Ambulatory Surgery Center Association (ASCA) reacted immediately with its own statement on the proposed rule. Read its full statement here. Highlights:

• CMS proposed to expand the ASC Covered Procedures List (ASC-CPL) for 2027 with 618 new codes. “Many of these codes, including all four of the hernia codes ASCA requested for inclusion, are procedures also proposed for removal from the inpatient-only (IPO) list for 2027,” stated ASCA.
• “CMS proposes removing a total of 637 procedures from the IPO list in 2027, continuing its transition to phase out the IPO list entirely.” Stated ASCA CEO Bill Prentice, “CMS’ proposal to continue to eliminate the [IPO] list will allow the clinical judgment of surgeons to determine where care can be best provided. While the great majority of these procedures will still be performed in the hospital for the foreseeable future, this change will spark advancements in clinical care that will lead to more procedures being available to patients in the more affordable and convenient outpatient setting.”
• CMS “concurred with ASCA’s request and proposed to continue to align the ASC update factor with the one used to update HOPD payments, extending the interim period an additional calendar year through 2027.”
• “If the proposed rule is finalized as drafted, ASCs would see, on average over all covered procedures, an effective update of 2.4%, which is a combination of a 3.2% inflation update based on the hospital market basket and a productivity reduction mandated by the Affordable Care Act of 0.8 percentage points. This is an average and the updates might vary significantly by code and specialty.”
• The top 10 ASC codes by volume are projected to see a decrease in reimbursement from 2026 rates for 2027. These include numerous codes related to cataract and colonoscopy procedures, along with three pain management codes. A full breakdown of these reimbursement changes is included in ASCA’s statement.
• CMS proposed to remove ASC-9: Endoscopy/Polyp Surveillance: Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients from the ASC Quality Reporting (ASCQR) Program.

ASCA stated that it will provide additional analysis soon, “including a rate calculator that allows users to determine what ASCs will be paid locally if the proposal is adopted.”

“We are gratified that CMS is proposing to keep ASC inflationary updates aligned with those of the hospital outpatient departments by use of the hospital market basket index,” stated ASCA President Todd Currier. “However, other payment policies will disincentivize ASCs from providing care to Medicare beneficiaries. For example, despite the inflation update, this proposal would actually reduce payments for the most common procedures that ASCs perform.”

“Beyond the continued elimination of the inpatient-only list, this rule proposal largely maintains the status quo in terms of ASC policy,” added Mr. Prentice. “We implore CMS leaders to work with us to generate policies that use the ASC model to provide more care to Medicare beneficiaries and in so doing save the program billions of dollars yearly. A recent study that ASCA commissioned by KNG Health Consulting showed that ASCs will generate more than $84 billion in savings to the Medicare program over the next 10 years because we exist as a lower-cost site of service. Imagine how many more billions of dollars could be freed up if surgery centers were incented to provide more care to the beneficiaries who require outpatient care.”

ASCA will offer a Regulatory Series session, “Understanding Medicare’s Proposed Rule for 2027,” exclusively to its members on Aug. 4 at 1:00 pm ET; it will be available on demand afterward. The session will be led by ASCA Chief Advocacy Officer Kara Newbury and ASCA Associate Director of Public & Regulatory Affairs Alex Taira.

Comments on the proposed rule are due August 31, 2026, ASCA stated.