By Bill Prentice
The Ambulatory Surgery Center Association has submitted comments on the Centers for Medicare & Medicaid Services’ 2027 proposed payment rule for ambulatory surgery centers and hospital outpatient departments, urging the agency to revise several policies that would affect ASC reimbursement.
Among our primary concerns, we stated the proposal would inadequately reimburse many of the procedures commonly performed in surgery centers.
Payment updates
We voiced support for CMS’ proposal to continue using the hospital market basket to calculate annual ASC payment updates.
If the rule is finalized as proposed, ASC payments would increase by an average of 2.4% across all covered procedures. That figure combines a 3.2% hospital market basket update with the 0.8 percentage-point productivity adjustment required under the Affordable Care Act. However, payment changes would differ depending on the procedure and specialty.
The hospital market basket was first adopted as a five-year test for ASC payment updates covering 2019 through 2023. CMS subsequently extended the policy through 2025 and again through 2026. In the 2027 proposed rule, the agency recommends another one-year extension while it continues evaluating outpatient utilization patterns and the migration of surgical procedures between hospitals and ASCs.
While ASCA welcomed the proposed extension, the association encouraged CMS to make the hospital market basket permanent or extend it for a longer period. To make its case, ASCA pointed out that a 2026 KNG Health Consulting study estimated that procedures performed in ASCs instead of HOPDs saved Medicare $27.9 billion in the years when rates were updated with the hospital market basket, including $5.1 billion in 2024 alone.
We also emphasized that ASC expenses – including staffing and anesthesia stipends – continue to increase at a pace that well exceeds the hospital market basket update.
The ASC weight scalar
ASCA urged CMS to address another key issue in the proposed rule: the 2027 ASC weight scalar.
CMS proposed lowering the weight scalar from 0.872 in 2026 to 0.809 in 2027. The agency attributed the reduction largely to the increasing number of device-intensive procedures being performed in ASCs, particularly orthopedic surgeries. Historically, the device portion of those procedures was excluded from the scalar so payment for implantable devices would remain aligned between the ASC payment system and the Hospital Outpatient Prospective Payment System. As more of these procedures move to ASCs, device-related spending now represents a larger share of overall ASC expenditures.
The proposed scalar would substantially reduce reimbursement for many high-volume procedures. All 10 of the most frequently performed Medicare procedures in ASCs are projected to receive lower payment than they do in 2026.
At the same time, CMS proposed payment increases for most device-intensive procedures, including total joint replacements. Reimbursement would rise 4% for total knee arthroplasty (CPT 27447), 5% for total hip arthroplasty (CPT 27130) and 7% for total shoulder arthroplasty (CPT 23472).
We again called on CMS to eliminate the ASC weight scalar, arguing that Congress required it only during the first year after the ASC payment system was linked to the HOPD payment system nearly two decades ago. Continuing to apply the adjustment conflicts with CMS’ goal of encouraging care in lower-cost outpatient settings.
Expansion of the ASC-CPL
ASCA expressed support for CMS’ proposal to expand the ASC Covered Procedures List. For 2027, CMS proposed adding 618 procedures to the ASC-CPL. Those additions include all four hernia procedures ASCA previously requested – CPT codes 49596, 49616, 49617 and 49618 – which CMS also proposed removing from the inpatient-only list.
In the comments, we supported CMS’ goal of allowing physicians to determine the most appropriate site of care for each patient. The association also encouraged the agency to eliminate the restriction that prevents ASCs from billing Medicare for unlisted procedure codes and pointed to reimbursement disparities that could continue to discourage migration of clinically appropriate procedures to surgery centers.
In addition, ASCA supported preserving physician discretion as CMS continues phasing out the IPO list but cautioned that eliminating the list entirely could have unintended consequences.
CMS proposed removing 637 of the remaining 1,438 procedures from the IPO list in 2027, continuing the three-year phaseout policy finalized last year. The procedures proposed for removal span several clinical areas, including auditory, digestive, endocrine, respiratory, urinary, integumentary, maternity, mediastinum and diaphragm, male and female genital, and hemic and lymphatic systems.
Although we support greater flexibility in determining the site of care, eliminating the IPO list means every procedure must be assigned to an ambulatory payment classification, even if it is unlikely to be performed in an outpatient setting. Projecting outpatient volume for those procedures could inadvertently reduce payment rates for procedures already included on the ASC-CPL.
ASC Quality Reporting Program
ASCA backed CMS’ proposal to remove ASC Quality Reporting Program measures that no longer provide meaningful value to patients or facilities. Specifically, the association supported CMS’ proposal to retire ASC-9, the Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients measure, beginning with the 2027 reporting period for the 2029 payment determination. ASCA agreed with CMS that ASC-12, the Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy measure, is more closely associated with patient outcomes.
Although those issues were not addressed in the proposed rule, ASCA also renewed concerns about two existing quality measures. The association again asked CMS to allow ASCs to administer the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems Survey through a web-only format to reduce costs. It also reiterated concerns about ASC-21, the patient-reported outcome measure for elective total hip and knee arthroplasty, because the required data are maintained by physician practices rather than surgery centers.
CMS did not propose any new ASCQR measures but requested feedback on whether ASC-4, the All-Cause Hospital Transfer/Admission measure, should distinguish between transfers that occur before, during and after a procedure. According to CMS, stratifying the measure by phase of care could make it more useful across the broad range of services provided in ASCs.
CMS is expected to release the 2027 final payment rule in early November.
