CMS’s proposed 2027 payment rule includes a 2.4% overall bump for ASCs. That number represents an average across hundreds of codes, and it collapses two things that are moving in opposite directions for different specialties: which procedures get approved for the ASC setting, and what those procedures actually pay.
Kara Newbury, chief advocacy officer of the Ambulatory Surgery Center Association told Becker’s that the update for ASC-covered procedures ranges from a 4% decrease to a 35% increase depending on the code and specialty group range.
“Although CMS says it’s an increase overall of 2.4%, it’s obviously going to vary greatly, depending on what procedures you’re looking at,” Ms. Newbury said.
Ophthalmology and GI: the most volume, the least payment relief
All 10 of the highest-volume ASC codes are projected to be reimbursed below their 2026 rates, and those codes sit in ophthalmology, gastroenterology and pain management. Both specialties maintain high ASC volumes, primarily via cataract surgeries and colonoscopies. While access to these procedures remain high, lowered rates will continue to put pressure on margins — especially with no new procedure-list expansion to offset it.
“It’s going to be very difficult for our facilities who are performing cataract surgeries, who are doing GI procedures, because they are all set to see a negative update,” Ms. Newbury said. “Costs are not going down. Their cost of equipment is not going down, the cost of personnel, nursing, other staff just running the facility is not going down.”
Spine pain management: a win and a cut in the same rule
Pain management shows the clearest version of the split. CMS’s procedure-list expansion continues to open doors, but analysis of the proposed 2027 rates shows four of the most common spine pain management codes taking direct cuts: transforaminal epidural steroid injection (CPT 64483) from $485.51 to $466.96, paravertebral facet joint injection (CPT 64493) from $485.51 to $466.96, facet joint radiofrequency ablation (CPT 64635) from $948.66 to $908.27, and interlaminar epidural injection (CPT 62323) from $387.46 to $372.75. These are high-frequency codes, so the per-procedure cuts compound fast. Pain management isn’t locked out of the ASC shift — it’s being squeezed inside it.
Orthopedics and general surgery: the clearest access winners
This is where the procedure-list expansion is landing hardest, and where payment remains more stable. CMS proposed adding 618 codes to the ASC Covered Procedures List for 2027, tracking 637 procedures proposed for removal from the inpatient-only list. Unlike the first phaseout year, which was largely musculoskeletal, this round adds real clinical complexity: laparoscopic colectomy, partial kidney removal, sleeve lobectomy and prostate-removal surgery. Orthopedics keeps building on its multiyear head start from the 2026 IPO changes, and general surgery is picking up genuinely new, higher-acuity case types it didn’t have access to before. Neither is facing the kind of top-code rate erosion hitting ophthalmology, GI or pain management.
Cardiology: the biggest structural win, on the slowest clock
CMS is proposing to remove roughly half of the remaining inpatient-only procedures in 2027, but it’s holding the cardiovascular family back until 2028, citing clinical complexity. This gives ASC necessary time to build out staffing, facilities and payer contracts before the volume shows up — but it also means cardiology won’t see this year’s rule move the needle the way it will for orthopedics or general surgery.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
