Federal policy is rapidly reshaping the ASC landscape in 2026.
From CMS expanding the covered procedures list to new prior authorization models and mounting reimbursement challenges, ASCs are at once facing major growth opportunities and new operational constraints. As payers and regulators push more care into outpatient settings, ASC leaders are being forced to navigate evolving rules, rising costs and increasing administrative complexity, all while positioning for the next phase of site-of-care transformation.
Here are five developments to know:
- CMS adds 573 codes to the ASC Covered Procedures List for 2026: In November, CMS finalized its 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule. The expansion included a significant number of spine and cardiovascular procedures, marking a major advocacy win for the Ambulatory Surgery Center Association and specialty groups.
What it means: The expanded CPL gives ASCs the green light to perform more Medicare procedures, particularly in spine and cardiovascular, opening new revenue and service line opportunities.
- CMS rolls out WISeR prior authorization pilot in 6 states: CMS’ Wasteful and Inappropriate Service Reduction model took effect Jan. 1, requiring prior authorization for select services in Arizona, Washington, New Jersey, Texas, Ohio and Oklahoma through 2031. The pilot applies to procedures including electrical nerve stimulator implants, epidural steroid injections (excluding facet joint injections), percutaneous vertebral augmentation and image-guided lumbar decompression. CMS will use AI-assisted and clinical review and plans to introduce a “gold carding” exemption for high-approval providers in 2026.
What it means: ASCs in participating states will face new authorization requirements for certain spine and pain procedures, adding administrative complexity and potential scheduling delays.
- Rising prior authorization rates strain ASC operations: As of 2024, 46% of ASC cases required preauthorization, up from 42% in 2023. ASC leaders say the growing volume is disrupting scheduling, increasing staffing demands and, when cases are delayed or denied, adding financial risk.
What it means: Even amidnew federal pilots, expanding prior authorization requirements can dictate ASC growth plans and operational strategy nationwide.
- Medicare payment updates aren’t keeping pace with ASC cost inflation: ASC leaders say CMS reimbursement increases have lagged behind rising labor and anesthesia costs, creating a widening financial disconnect. Many centers now rely on anesthesia stipends and face immediate implant and supply expenses that are often bundled or delayed in payment.
What it means: Federal payment policy may not be evolving fast enough to support continued migration of higher-acuity cases into ASCs.
- Nearly 50 insurers pledge major prior authorization reforms starting in 2026: Nearly 50 major insurers announced voluntary commitments to simplify prior authorization across commercial, Medicare Advantage and Medicaid managed care plans, potentially affecting 257 million Americans. Plans include reducing prior authorization requirements, which began Jan. 1, moving toward standardized electronic processes, with a goal of earning 80% of approvals in real time by 2027 and getting clearer explanations for denials and appeals.
What it means: While ASC leaders remain cautious about execution, the reforms could ease administrative burden and reduce delays that have long frustrated outpatient surgery centers.
