CMS is expected to release its final calendar year 2027 outpatient and ASC payment rule in early November, with rates taking effect Jan. 1.
The proposed rule, released July 2, would raise ASC payment rates 2.4% on average and add 618 procedures to the ASC covered procedures list. But all 10 of the highest-volume ASC procedures would be paid less in 2027, and the Ambulatory Surgery Center Association projects ASC payment for the top 100 procedures would fall to 44% of the hospital outpatient rate.
The rule drew 2,180 public comments before the Aug. 31 deadline, nearly a third of them on the final day. It will land alongside the final 2027 physician fee schedule, which sets pay for the surgeons and anesthesiologists who own and staff ASCs.
Here is what to watch in the final rule, and what ASC leaders have told Becker’s since the proposal was released.
Payment rates and the weight scalar
The update. The 2.4% increase reflects a 3.2% hospital market basket update minus a 0.8 percentage point productivity adjustment. Hospital outpatient departments would get the same 2.4%.
Conversion factors. The ASC conversion factor would rise to $57.766 from $56.322 for centers meeting quality reporting requirements. The HOPD conversion factor would be $102.004.
Market basket. CMS proposed using the hospital market basket, rather than a lower consumer inflation index, to update ASC rates for a ninth straight year. ASCA wants the alignment made permanent.
The scalar fight. CMS proposed lowering the ASC weight scalar to 0.809 from 0.872, pulling down relative weights for most common procedures. An ophthalmology coalition tied the drop to CMS’ 340B proposal, which would redistribute savings into other outpatient payments.
The gap with hospitals. ASCA projects ASC payment for the top 100 procedures by Medicare volume would fall from 53% of the HOPD rate this year to 44% in 2027, with 85 of those codes facing cuts.
What ASCA asked for. In Aug. 31 comments, ASCA asked CMS to:
- Eliminate the ASC weight scalar
- Permanently align ASC and HOPD updates under the hospital market basket
- Extend hospital wage index protections to rural ASCs
- Let ASCs bill unlisted procedure codes
- Delay the ASC-21 patient-reported outcomes measure for hip and knee replacement
- Let ASCs bill unlisted procedure codes
ASCA cited research showing ASCs saved Medicare $5.1 billion in 2024. As of June 2026, 6,640 Medicare-certified ASCs were operating, more than half with two or fewer operating rooms.
Procedure-level winners and losers
The 2.4% figure is an average. Updates vary widely by specialty, from cuts of up to 4% to increases as large as 35%, and because the system is budget neutral, gains for higher-cost codes are offset by cuts elsewhere.
The top 10 all go down. Every one of the 10 highest-volume ASC procedures, concentrated in ophthalmology, GI and pain management, would be paid less in 2027, per ASCA:
| Code | Procedure | 2026 final | 2027 proposed | Change |
| 66984 | Cataract surgery | $1,255.73 | $1,211.57 | -$44.16 (-3.5%) |
| 64635 | Lumbar facet radiofrequency ablation | $948.66 | $908.27 | -$40.39 (-4.3%) |
| 45385 | Colonoscopy with lesion removal | $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 | $301.90 | $291.78 | -$10.12 (-3.4%) |
Ophthalmology. Cataract surgery accounts for 18% of Medicare fee-for-service ASC volume, according to the Medicare Payment Advisory Commission. Because cataract patients are overwhelmingly Medicare beneficiaries, centers have little room to shift volume. Ophthalmology drew 115 comments, including 29 letters seeking separate payment for Dextenza.
GI. Digestive procedures face a projected 2% aggregate cut, the largest among the six highest-spending ASC surgical groups outside eye procedures. No procedure list expansion offsets the lower rates.
Pain management. Four common spine pain codes face direct cuts. Interventional pain drew 129 comments, with template letters opposing cuts to eight procedures and at least 77 opposing a multiple-procedure reduction for stimulator implants.
Orthopedics. Total joints gain on the facility side. The ASC rate for total knee replacement (CPT 27447) would rise 4.2% to $9,787, and total hip replacement (CPT 27130) 5.1% to $10,108, according to the American Association of Hip and Knee Surgeons. Total shoulder replacement would rise almost $1,000.
Cardiology. Newer cardiovascular codes ASCA requested are proposed for a substantial increase.
Covered procedures list and inpatient-only phaseout
618 new ASC codes. CMS proposed adding 618 codes to the ASC covered procedures list, including four hernia codes ASCA requested after a prior coding change pushed some hernia procedures onto the inpatient-only list. “That was a good pickup for us,” said Kara Newbury, ASCA’s chief advocacy officer.
Complex surgery moves in. Additions include laparoscopic colectomy, partial kidney removal, sleeve lobectomy and prostate removal.
Inpatient-only list. CMS proposed removing 637 services in 2027, the second year of a three-year phaseout and roughly half of the remaining list. Digestive procedures are included. The cardiovascular family is held until 2028 because of clinical complexity.
Bariatrics. The inpatient-only list drew about 290 comments, including 122 on bariatric surgery. Surgeons largely supported removing eight bariatric codes.
Leaders say access is outpacing payment.
“ASCs are happy to take on more procedures, but they cannot carry the burden of all increasing costs,” Patrick McEneaney, DPM, owner and CEO of Northern Illinois Foot & Ankle Specialists in Crystal Lake, told Becker’s.
Site-neutral, 340B, quality and other provisions
Site-neutral imaging. CMS would pay off-campus HOPDs physician fee schedule-equivalent rates for imaging without contrast, such as X-rays and MRIs, cutting Part B spending an estimated $260 million in the first year, including $70 million in beneficiary savings. The proposal drew about 850 comments.
340B. CMS proposed paying 340B drugs at average sales price minus 33.4%, down from ASP plus 6%, with savings funding an 8.44% increase in other outpatient payments. It was the most commented-on provision, with about 1,010 submissions. Providence estimated losses of $90 million to $100 million a year.
Quality reporting. CMS proposed removing ASC-9, the follow-up interval measure after normal colonoscopy, because performance has topped out, and proposed no new ASC measures. It also sought input on stratifying the All-Cause Transfer/Admission measure by phase of care.
Botulinum toxin. Citing a 42.8% rise in claim volume from 2017 to 2024, CMS proposed prior authorization for eight codes starting July 1, 2027. Nearly all 153 comments opposed it.
Price transparency. CMS issued a request for information on standardizing hospital price transparency data formats.
The physician-side pressure on ASCs
Physician fee schedule. The companion 2027 physician fee schedule proposal would cut the conversion factor 1.68% clinicians not in qualifying alternative payment models. Surgeon pay for total hip and knee replacement would fall about 20%.
“Changes to physician payment can influence practice patterns and, in turn, ASCs,” Alex Taira, ASCA’s associate director of public and regulatory affairs, told Becker’s. Mike Boblitz, CEO of Athens (Ga.) Orthopedic Clinic, urged CMS to add a payment incentive for orthopedic surgery performed in ASCs.
Ambulatory Specialty Model. The mandatory model starts Jan. 1, 2027, tying Part B pay for more than 5,500 heart failure and low back pain specialists, including orthopedic surgeons, neurosurgeons and pain physicians, to cost and quality. Spinal surgeries, injections and neurostimulators count toward low back pain episode spending, putting ASC pain and spine volume under the model’s cost lens.
CJR-X. The mandatory Comprehensive Care for Joint Replacement Expanded model starts Jan. 1, 2028. CMS intends to price low-acuity episodes the same in an HOPD or ASC, but accountability rests with hospitals, and CMS has not said how it will attribute episodes performed at freestanding, physician-owned ASCs. Hospitals may share savings with ASCs under an Anti-Kickback Statute safe harbor.
“This will also undoubtedly increase the outmigration of joint replacement to ambulatory surgery centers,” Sean Bak, MD, orthopedic surgeon at Motor City Orthopedics in Novi, Mich., told Becker’s.
What ASC leaders told Becker’s
Kara Newbury. Chief Advocacy Officer of the Ambulatory Surgery Center Association: Although CMS says it’s an increase overall of 2.4%, it’s obviously going to vary greatly, depending on what procedures you’re looking at. It’s going to be very difficult for our facilities who are performing cataract surgeries, who are doing GI procedures, because they are all set to see a negative update. Costs are not going down. Their cost of equipment is not going down, the cost of personnel, nursing, other staff just running the facility is not going down.
Todd Currier. President of the Ambulatory Surgery Center Association: Other payment policies will disincentivize ASCs from providing care to Medicare beneficiaries. This proposal would actually reduce payments for the most common procedures that ASCs perform.
Julie Jackson. Chief Administrative Officer of GI Associates (Milwaukee): The policy that concerns me most is the proposed ASC payment methodology, which produces a headline 2.4% update but still reduces reimbursement for many of the highest-volume procedures performed in our endoscopy centers. For example, the proposed national rates would decrease payment for colonoscopy with lesion removal and colonoscopy with biopsy by about $20 per case, and EGD with biopsy by about $15 per case. All 10 of the highest-volume ASC procedures are projected to receive lower reimbursement despite the stated update.
Adam Bruggeman, MD. CEO and Surgeon of Texas Spine Care Center (San Antonio): The ASC weight scalar introduced in 2007/2008 continues to create issues and threatens ASCs long term. CMS proposes to reduce the scalar related to 340B changes in the hospital fee schedule, which has the effect of lowering payment for 85 out of the top 100 highest-volume ASC procedures. ASC rates are now falling from about 53% to 44% of the hospital rate. This continues to undercut CMS’s own goal of moving care to lower cost settings while simultaneously adding 618 procedures to the ASC list. We need to get rid of the scalar once and for all as so many of the societies have requested over the years.
Michael Boblitz. CEO of Athens Orthopedic Clinic (Athens, Ga.): Funding a 2.4% increase to hospital outpatient services in 2027 by cutting physician reimbursement under Medicare Part B is not good, and only accentuates the increased shortage of physicians that cannot sustain further cuts. CMS should expand the incentive introduced in 2026 to perform more work in physician offices to the ASC setting in 2027, for example by increasing physician reimbursement by 3% or more for orthopedic surgery performed in ASCs. That rewards physicians for working in lower-cost settings and results in a net overall savings to Medicare Part B by shifting cases from higher-cost hospital settings.
Neeraja Kikkeri. CEO of North Texas Team Care Surgery Center (Mesquite, Texas): What concerns me most is the proposed 2.4% payment increase. This is not a good increase reflecting the economics of today. At our independent ASC, we still must pay for staffing, anesthesia coverage, and supplies, and that increase leaves little room to absorb rising costs. Allowing more procedures in ASCs is helpful, but we must be able to afford to do them. For some cases, the implant alone can cost more than Medicare pays.
Raghu Reddy. Chief Administrative Officer of MiOrtho Surgery Center (Southfield, Mich.): As CAO of a multispecialty ASC, my biggest concern is the 2.4% payment update. Our staffing, anesthesia, and supply costs are rising faster than CMS’s forecast, so each ‘increase’ is really a margin cut. CMS wants ASCs to take on more complex cases as the inpatient-only list shrinks, but it has to pay what those cases actually cost.
Brian Cohen, MD. CEO of Miami Anesthesia Services (Miami): My main concern is that the payment methodology is not keeping pace with the policy to support these more complex cases in the ASC. I am confident that my anesthesia colleagues will continue to act as responsible gatekeepers for this shift, using patient selection to direct each case to the safest and most appropriate setting. If payment can be aligned to support this migration, everyone benefits.
Travis Doering, MD. Owner of Upper Extremity ATX (Austin, Texas): I’m an independent hand surgeon operating in a physician-owned surgical hospital, and I’m not opposed to moving appropriate cases to lower-cost settings. Most hand surgery should be outpatient. My concern is that payment policy is moving faster than the evidence on patient selection. I’d like to see CMS pair site-neutral payment with site-neutral regulation, so physicians can choose the setting based on the patient rather than the payment.
Ed Tolentino. Administrator of Outpatient Surgery Center of Central Florida (Wildwood): Reimbursement compression has become a structural reality in healthcare, not an isolated event. While we anticipated continued pressure on physician payments and have planned accordingly, further reductions increase the importance of operational efficiency, physician alignment, and disciplined growth. From our perspective, these changes reinforce, not change our long-term strategy.
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.
