All 10 of the highest-volume ASC procedures would be paid less by Medicare in 2027 under CMS’ proposed outpatient payment rule, even though the agency proposed a 2.4% average rate increase for ASCs.
CMS released the proposed rule July 2. The 2.4% update is based on a 3.2% hospital market basket increase, reduced by a 0.8 percentage point productivity adjustment. It raises the ASC conversion factor to $57.766 from $56.322 for centers that meet quality reporting requirements. But CMS also proposed lowering the ASC weight scalar to 0.809 from 0.872. That pulls down relative weights and offsets the update for most common procedures.
The scalar would cut payments for 85 of the top 100 ASC procedures by Medicare volume in 2027, the Ambulatory Surgery Center Association wrote in Aug. 31 comments to CMS. For those 100 procedures, ASCA projects ASC payment would fall to 44% of the hospital outpatient rate from 53% this year. The association asked CMS to eliminate the scalar.
Here is how the proposed national rates for the 10 highest-volume ASC procedures compare with 2026, according to ASCA:
| Code | Procedure | 2026 final | 2027 proposed | Change |
| 66984 | Cataract surgery | $1,255.73 | $1,211.57 | -$44.16 (-3.5%) |
| 64635 | Lumbar facet nerve destruction (radiofrequency ablation) | $948.66 | $908.27 | -$40.39 (-4.3%) |
| 45385 | Colonoscopy with lesion removal (snare) | $656.75 | $636.74 | -$20.01 (-3%) |
| 45380 | Colonoscopy with biopsy | $656.75 | $636.74 | -$20.01 (-3%) |
| G0105 | Screening colonoscopy, high risk | $510.49 | $494.01 | -$16.48 (-3.2%) |
| 43239 | Upper GI endoscopy with biopsy | $497.85 | $482.98 | -$14.87 (-3%) |
| 64483 | Transforaminal epidural injection, lumbar | $485.51 | $466.96 | -$18.55 (-3.8%) |
| 64493 | Lumbar facet joint injection | $485.51 | $466.96 | -$18.55 (-3.8%) |
| 62323 | Lumbar epidural injection with imaging | $387.46 | $372.75 | -$14.71 (-3.8%) |
| 66821 | YAG laser capsulotomy (post-cataract) | $301.90 | $291.78 | -$10.12 (-3.4%) |
Cataract surgery accounts for 18% of Medicare fee-for-service ASC volume, according to the Medicare Payment Advisory Commission’s March 2026 report. Total joint replacement moves the other way. The proposed ASC rate for total knee replacement (27447) would rise 4.2% to $9,787 from $9,393, and total hip replacement (27130) would rise 5.1% to $10,108 from $9,614, according to the American Association of Hip and Knee Surgeons.
CMS also proposed adding 618 procedures to the ASC covered procedures list and removing 637 services from the inpatient-only list.
ASCA President Todd Currier said that despite the inflation update, “other payment policies will disincentivize ASCs from providing care to Medicare beneficiaries,” adding that “this proposal would actually reduce payments for the most common procedures that ASCs perform.”
CMS is expected to release the final rule in early November, with rates effective Jan. 1.
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