ASCs are entering 2026 in a tough spot: pay updates are landing, but many leaders say they’re still being squeezed by inflation, payer tactics and rising procedure complexity.
Five dynamics, in particular, are shaping the ASC reimbursement picture heading into 2026:
- CMS finalized a 2.6% ASC payment increase for 2026 and signaled continued use of the hospital market basket: In 2026 CMS updated the ASC payment rate by 2.6%, using the hospital market basket update. Hospital outpatient departments that meet quality reporting requirements will also receive a 2.6% increase. CMS said it plans to continue using the hospital market basket update for ASCs next year while monitoring its impact.
For 2026, the ASC conversion factor is $56.322, compared with $91.415 for hospital outpatient departments, a gap that ASC leaders say continues to underscore longstanding structural payment challenges, even as CMS acknowledges surgery centers can safely perform a broader range of procedures.
- Rising device costs are squeezing ASC margins and reshaping operations: ASC leaders say higher device, implant and supply costs, fueled by inflation and technology investment, are increasingly outpacing reimbursement, tightening per-case margins across service lines.
While the impact varies by specialty, many centers report pressure on case profitability, particularly for high-cost or implant-heavy procedures. In response, ASCs are prioritizing vendor negotiations, group purchasing organization leverage, device standardization and bundled case costing, while reexamining case mix, scheduling efficiency and capital planning to protect access and financial sustainability.
- Payer denials and delays are adding friction and cost to ASC revenue cycles: ASC leaders report insurers are increasingly using prior authorization denials, requests for additional documentation, medical necessity disputes and bundling tactics to delay, deny or reduce payment. While many initially denied claims are eventually paid, leaders say the administrative burden and lag time strain cash flow and drive up revenue cycle costs.
Others report payer resistance around reimbursement for newer devices and pharmaceuticals, including carve-outs and contract interpretation disputes, prompting ASCs to devote more resources to appeals and contract renegotiation, particularly as scrutiny around Medicare Advantage plans intensifies.
- Anesthesia reimbursement cuts are creating a volatile financial pressure point for ASCs: Payer policy changes are tightening anesthesia margins, with UnitedHealthcare implementing a 15% pay cut for independently practicing CRNAs in select states and eliminating payments for key modifiers. These moves follow an 8.2% decline in CMS anesthesia reimbursement from 2019 to 2024 and another 2.83% cut in 2025.
As ASCs expand into higher-acuity procedures requiring longer anesthesia time, rising labor costs and falling reimbursement are forcing centers to renegotiate anesthesia arrangements and prioritize tighter financial alignment to maintain coverage and access.
- ASC leaders are pushing for payment reform, broader procedure access and streamlined quality reporting: The Ambulatory Surgical Center Association has made reimbursement policy a top priority, warning that modest payment updates and structural rate-setting mechanisms, including the ASC weight scaler, limit Medicare savings and discourage centers from taking on more Medicare patients. The organization continues to advocate for permanent use of the hospital market basket to keep ASC inflation updates aligned with hospital outpatient departments.
ASCA is also pressing CMS to expand the ASC covered procedures list, particularly for cardiac and spine cases, and to place greater weight on physician clinical judgment in site-of-care decisions. On quality reporting, the group supports safety-focused measures but is urging CMS to roll back untested, burdensome requirements that could discourage participation.
