ASCs’ looming non-opioid payment cliff : 7 things to know 

ASCs have less than 15 months before a federal payment for non-opioid pain management products is set to expire, and the 2027 Medicare OPPS/ASC proposed rule does not extend the payment. 

Here are seven things to know:

1. The NOPAIN Act was signed Dec. 29, 2022, as part of the Consolidated Appropriations Act. It changed how facilities are paid: Medicare must stop packaging certain non-opioid treatments for pain relief into the procedure payment and must make a separate, additional payment for them in hospital outpatient departments and ASCs.
2. The payment is temporary. It runs from Jan. 1, 2025, through Dec. 31, 2027, according to CMS. As of Oct. 14, no extension had been enacted.
3. Before the law, ASCs that chose these products paid for them out of their own procedure payment. Under ordinary payment rules, most drugs, biologicals and single-use devices used during a procedure are packaged: the facility gets one payment and the supplies are assumed to be inside it. A facility choosing a costlier non-opioid analgesic absorbs the difference. The NOPAIN Act aims to create parity by removing non-opioid options from that bundled payment.
4. The list of eligible products has grown. As of January, 18 non-opioid alternatives are available for separate Medicare reimbursement under the act, up from 11 codes eligible in 2025, according to the Ambulatory Surgery Center Association. Products include liposomal bupivacaine, infusion pumps and cold therapy systems. CMS maintains the current list of qualifying products.
5. Payment is capped. The separate payment cannot exceed an estimated average of 18% of the hospital outpatient fee schedule amount for the service the treatment is used with. CMS calculates the cap using the top five outpatient procedures by volume for each product. The ceiling tracks the payment for the procedure, not what the facility paid the manufacturer.
6. The dollars per case are significant for some devices. For example, Medicare payment caps for 2026 are $2,008.72 for Avanos Medical’s ON-Q and ambIT pumps and $1,997.16 for the Game Ready system when used with covered surgical procedures and deemed medically necessary.
7. The American Society of Interventional Pain Physicians flagged the deadline in its analysis of the proposed 2027 payment rule. It advised practices to budget for 2028 if they rely on qualifying products. The ASCA has partnered with Voices for Non-Opioid Choices and lobbied Congress and CMS for access to non-opioid alternatives. The law also requires HHS to report to Congress on limitations, gaps or barriers to access and recommend improvements to Medicare coverage of non-opioid alternatives.

At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.