CMS 2026 Proposed Rule: Opportunity or Risk for ASCs?

The recently released CY 2026 Medicare Proposed Rule (CMS-1834-P) brings a mix of optimism and caution for Ambulatory Surgical Centers (ASCs) and healthcare providers. At LeftCoast Healthcare, we’ve taken a close look at the proposed changes—and while the direction is promising, the implications are complex.

What We Like in the Proposed Rule

An Increase in Rate, But Not Nearly Enough

As of June 2025, the annual inflation rate in the U.S. was 2.7%, according to the U.S. Bureau of Labor Statistics (BLS). CMS is proposing an overall adjusted increase of 2.4% is positive. However, when coupled with the fact that ASCs are still being reimbursed at approximately 60% of their HOPD counterparts for doing the same procedure, an increase of 2.4% just isn’t enough.

Continued Use of Hospital Market Basket Methodology

CMS is also proposing the continuing use of the same site-neutral payment alignment methodology for both Hospital Outpatient Departments (HOPDs) and ASCs. This is a win as this methodology was originally meant to be temporary but will be extended through 2026.

Three-Year Phase-Out of the Inpatient Only (IPO) List

CMS plans to phase out the IPO list over a 3-year period, beginning with removing 285 mostly musculoskeletal procedures from the list in 2026. Gradual transition allows for thoughtful implementation and clinical oversight. This is potentially a smart move that balances innovation with patient safety. However, ASCs should remain cautiously optimistic as the last time CMS removed procedures from the IPO list in 2021, it swiftly reversed course, adding almost 300 procedures back to the IPO list in March of 2022.

Physician-Led Oversight of the ASC Covered Procedures List (ASC CPL)

CMS proposes 3 key revisions to the ASC Covered Procedures List. First, the move of 5 general inclusion criteria from the ASC CPL to a new, nonbinding section focused on physician-led safety considerations. Second, CMS proposes adding 276 procedures to the ASC CPL and, lastly, the removal of 271 codes from the IPO list. We support this shift toward a more clinically informed, transparent process and increasing options for ASC patients.

Continued Emphasis on Hospital Pricing Transparency

In addition to a February 25, 2025 Executive Order targeting healthcare pricing transparency, CMS is proposing several additional hospital-specific provisions. Under the proposal, starting in 2026, hospitals will be required to disclose additional details on payer-specific negotiated charges that are based on formulas to better reflect the actual prices paid for services. In addition, they will be required to utilize the EDI 835 (also known as the Electronic Remittance Advice) standards and provide encoded national provider identifiers (NPIs) to enable better comparability between hospitals. Transparency is essential for a functioning healthcare marketplace. We applaud CMS for expanding the use of existing data standards and keeping data access front and center.

Ambulatory Surgical Center Quality Reporting (ASCQR) Program Updates

CMS proposes several changes to the reporting requirements for ASCs. The proposed removal of several measures is consistent with feedback from industry and trade groups regarding the importance of aligning metrics with ASC processes and the inherent limited impact ASCs have on patient population management efforts. As such, CMS proposes removing several reporting requirements for:

− COVID-19 Vaccination Coverage Among Health Care Personnel (ASC-20)
− Screening for Social Drivers of Health (ASC-22)
− Screen Positive Rate for SDOH (ASC-23)
− Facility Commitment to Health Equity (ASC-24)

Additionally, CMS has proposed adding the Patient Understanding of Key Information Related to Recovery After a Facility-Based Outpatient Procedure or Surgery (also known as the “Information Transfer PRO-PM”) to measure communication with patients regarding recovery. Voluntary reporting would begin in CY2027 followed by mandatory reporting in CY2029. CMS will also require ASCs to submit data via the pay-for-reporting platform called the Hospital Quality Reporting (HQR) Program already in use for Total Hip & Knee Arthroplasties. We are supportive of quality reporting if paired with regular review of requirements and submission processes.

But Here’s the Catch: Commercial Reimbursement Risk

While these changes may increase potential procedural volumes at ASCs, they also open the door to rate compression in the commercial market. Here’s why:

Commercial payors often peg rates to Medicare benchmarks.

When CMS moves procedures to the ASC CPL, payors may use this as justification to lower commercial rates—even for procedures previously negotiated at sustainable levels.

No good ASC-specific Medicare cost benchmarks exist.

Without a strong ASC cost benchmark, commercial payors default to Medicare based pricing. This can lead to downward pressure on reimbursement, especially in markets already facing stagnation or retraction.

The result?

More potential volume, but potentially less revenue per case making it harder for ASCs to cover their costs and reinvest in quality care.

Final Thoughts

CMS’s 2026 Proposed Rule is a step in the right direction—but like all big CMS moves, the devil is in the details. As the public comment period unfolds, we’ll be watching closely and advising our partners on how to adapt and thrive.

How LeftCoast Healthcare Advisors Can Help

At LeftCoast Healthcare, we specialize in helping providers turn regulatory change into strategic advantages. Here’s how we support our partners: