In November, CMS finalized its Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule for 2026, which included the addition of 573 codes to the ASC Covered Procedures List.
The update represented a significant advocacy win for the Ambulatory Surgery Center Association, which has long pushed for ASC-CPL expansion — especially for spine and, increasingly, cardiovascular procedures.
“Every year, we’re finding there’s more and more procedures that can be performed, on some patients at least, in an outpatient setting,” Bill Prentice, CEO of ASCA, told Becker’s in February 2025. “That’s the trend for a lot of healthcare — moving out of the hospital into different sites of care that are more targeted and more efficient.”
Kara Newbury, ASCA’s chief advocacy officer, said that the policy win came from a collaborative effort between ASCA and specialty organizations.
“For the past few years, [ASCA has been] working with the Heart Rhythm Society, the American College of Cardiology…and they really took it and ran with this effort,” she said.
She added that in the Social Security Act, CMS states that it will consult physicians about potentially adding codes — but the process does not always play out so consistently.
“But because we are all aligned with this effort, and because the ACC and Heart Rhythm Society were very active in advocating for the addition of these codes, it made it move a lot more seamlessly than it sometimes does for different specialties,” Ms. Newbury said.
In this case, the specialty organizations had their subject matter specialists speak to how these procedures can be performed safely in the ASC and how adding the codes would increase access for Medicare beneficiaries.
“If at all possible, that’s how ASCA likes for it to go—working closely with and in conjunction with the specialty organizations,” Ms. Newbury said. ASCA also supports specialty organizations’ efforts through submitting comment letters, codes for approval and encouraging its members to reach out and support the code expansion.
Spine procedures comprised another sizable share of the codes added to the CPL. That advocacy effort required a different approach, Ms. Newbury said.
“We had a spine surgeon in the ASC space who was able to perform a lot of the lumbar fusion codes during the COVID-19 pandemic when CMS created a Hospital Without Walls Program, as that allowed ASCs to expand upon what they could do,” she said. “And that was a great opportunity to showcase how those spine codes could safely be done on the Medicare population.”
Having Medicare population-specific data is very important, but challenging, Ms. Newbury said. CMS is most concerned about whether procedures can be safely performed on this population specifically, but many ASCs take on a high percentage of patients through private insurance.
“[The spine physicians] published this data, and it still took a few years working with CMS and providing that information to them,” Ms. Newbury said. “But they did, for 2026, finally add those codes, allowing access to the entire country now for those spine codes.”
She also said that there has been a general “mindset shift” among lawmakers and the general public as ASCs become more widely utilized across the country and a more regular part of people’s healthcare experience.
Moving forward, enhanced data collection and analysis will be the most important tools for continued ASC advocacy, she said.
“While one physician anecdotally talking about their experience is nice, being able to collectively present data from multiple facilities—benchmarking is important, registries are great—having everybody pull together and provide as much data as possible, and being able to say there were 5,000 procedure done safely is probably more impactful than [one facility] being able to speak to their 75 or 100 procedures.”
This ties into a common theme behind the expansion of the ASC space overall — efficiency.
“Just like ASCs have to be efficient, we have to be efficient in our advocacy,” she said. “We have to cut through the noise and really be able to provide compelling information in a quick and easy to digest fashion to CMS.”
