CMS's 2026 ASC Rule: 573 New Procedures, 2.6% Raise

CMS's Calendar Year 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center final rule raises ASC and OPPS payment rates 2.6% and adds 573 procedure codes to the ASC Covered Procedures List, effective January 1, 2026. That update is smaller than the 2.9% raise ASCs got for 2025, but the procedure list grew far more than the rate did.

The 2.6% figure comes from a 3.3% hospital market basket increase reduced by a 0.7 percentage point productivity adjustment, according to CMS's fact sheet on the final rule. For an independent practice or ASC weighing a facility contract or a new service line, this rule touches three separate numbers at once: the base payment rate, the list of procedures Medicare will pay a surgery center to perform, and the penalty for skipping quality reporting.

A Smaller Raise Than Last Year

CMS finalized a 2.6% update to both OPPS and ASC payment rates for CY2026, down from the 2.9% update ASCs and hospital outpatient departments received for CY2025, according to CMS's final rule fact sheets for both years. The drop traces to a lower market basket estimate, 3.3% for 2026 versus 3.4% for 2025, cut by a productivity adjustment that grew from 0.5 percentage points to 0.7 percentage points.

The dollar effect shows up in the conversion factor, the number Medicare multiplies against a procedure's relative weight to set payment. The CY2026 ASC conversion factor is $56.322, up from $54.895 in CY2025. The CY2026 hospital outpatient conversion factor is $91.415, per CMS's fact sheet. A cataract extraction billed under CPT 66984, one of the highest-volume ASC procedures, gets roughly a 3.4% payment increase over 2025 rates under the new rule, according to the Ambulatory Surgery Center Association's review of the CMS payment tables.

Metric	CY2025	CY2026
OPPS/ASC payment update	2.9%	2.6%
Hospital market basket increase	3.4%	3.3%
Productivity adjustment	0.5 point	0.7 point
ASC conversion factor	$54.895	$56.322

Source: CMS CY2025 and CY2026 OPPS/ASC final rule fact sheets.

573 New Procedures Land on the ASC List

The rule expands the ASC Covered Procedures List by 573 codes for 2026, according to ASCA's count of the finalized CMS tables. Of that total, 271 codes move over from the Medicare Inpatient Only list, which CMS trimmed by 285 procedures this year. CMS's own fact sheet puts the revised-criteria additions at 289 procedures, while ASCA's review of the underlying rule tables counts 302, a gap the two sources have not reconciled in their public materials.

The newly eligible procedures include cardiovascular ablations such as catheter-based treatment for atrial fibrillation, plus several spinal fusion and other previously inpatient-only spine codes, according to ASCA. For a multi-specialty ASC, that list determines which cases can move out of a hospital operating room and into a lower-overhead surgery center, provided the facility has the equipment and staffing to take them on.

Where CMS Found the Savings

CMS estimates its expanded drug administration payment policy will cut OPPS spending by $290 million, split into $220 million in Medicare savings and $70 million in reduced beneficiary coinsurance, according to the rule's fact sheet. The rule also adds a $10 per-dose payment for Tc-99m produced from domestically sourced Mo-99, provided at least 50.0% of the Mo-99 used is domestically produced.

On the hospital side, CMS is continuing a 0.5 percentage point reduction to the non-drug OPPS conversion factor, part of a plan to offset $7.8 billion in payments CMS says hospitals received above the true acquisition cost of packaged drugs between CY2018 and CY2022.

Quality Reporting Still Carries a Penalty

Hospitals and ASCs that skip their quality reporting requirements still face a 2.0 percentage point cut to their payment update under the final rule, a policy CMS says applies to roughly 4,000 hospitals and 6,000 ASCs nationally. The rule also removes 3 measures from the ASC Quality Reporting Program and declines to finalize a proposed patient-reported outcome measure on information transfer, according to ASCA's summary of the rule.

Most CY2026 provisions took effect January 1, 2026, though CMS delayed enforcement of a related hospital price transparency requirement to April 1, 2026.

What This Means for a Practice or ASC

For an independent practice weighing a facility-fee renegotiation or an ASC deciding whether to add a service line, the 2.6% base increase is smaller than administrators saw last year, and the 573-code list expansion is the bigger practical change to plan around. Ron Grace, a principal at the law firm Polsinelli, told ASC News that ASCs will face extra costs to perform the newly eligible procedures, and that those costs can strain physician-owner partnerships when equipment upgrades benefit only some of the owners.

Practices that bill facility fees or co-manage an ASC should check the updated ASC-CPL and Inpatient Only list changes against their own case mix before assuming the rule is a net gain. A 2.6% rate increase on unchanged procedure volume is a small effect next to the capital decision behind adding a new, equipment-intensive procedure line.

Billing and coding staff should also confirm which of the 573 added codes their payer contracts already reference, since a code appearing on the Medicare ASC-CPL does not automatically mean a commercial payer will reimburse it at the ASC site of service. Administrators who track both the CY2026 conversion factor and their own commercial fee schedules will have a clearer read on whether a given new procedure pays enough to justify the equipment cost Grace and other ASC advisors are flagging.

Sources

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