Here are six payer updates since the start of 2026 that ASC should know:
1. CMS finalized a 2.6% payment increase for ASCs in its November rule, continuing its use of the hospital market basket update, but SCA Health executives warn the technical adjustments in the payment calculation continue to dilute the real-world impact of the increase.
2. The acquisition of ASCs by UnitedHealth Group’s Optum, parent company of ASC chain SCA Health, was associated with double-digit price increases for competing insurers, according to a February study published in Health Affairs.
3. ASCs will continue to receive separate Medicare reimbursement for certain non-opioid pain management devices in 2026 under the NOPAIN Act.
4. Medicare Advantage markets remain highly concentrated across the U.S., according to the American Medical Association’s new report, “Competition in Health Insurance: A Comprehensive Study of U.S. Markets.”
5. Fee-for-service Medicare payments per beneficiary receiving care at ASCs rose sharply over the past year, increasing 13.1% from 2023 to 2024, according to MedPAC Medicare carrier claims data published Jan. 15.
6. UnitedHealthcare is updating its reimbursement policy for radiology services billed with evaluation and management services for dates of service on or after April 1.
