An ASC’s commercial reimbursement can change even when no one has reopened the contract, according to a payer-contracting consultant.
At Becker’s Spine, Orthopedic and Pain Management-Driven ASC Conference 2026 in June, Amy Colletti, a principal at ECG Management Consultants, said UnitedHealthcare pays ASCs using its own grouper methodology rather than a percentage of Medicare. United adds new codes in January and remaps codes every July, she said.
“Even if you haven’t renegotiated your contract, they could move a code from group 8 or 9 to group 3, and all of a sudden you have a change in reimbursement,” she said. “You want to make sure someone in your office is checking those grouper changes.”
The session’s central message was that no two payers price ASC services the same way.
“If you’ve seen one payer methodology, you’ve seen one payer methodology,” Ms. Colletti said.
Here is how she described four major payers’ approaches to ASC contracting:
- UnitedHealthcare: A national contracting team handles most of the country, and ASCs can’t contact a contract manager directly. Renegotiation requests go through an online process, she said. The Southeast still has local contracting staff, including in Florida, Georgia and possibly the Carolinas. She said United often carves out spine and total joint codes at set rates.
- Aetna: “Aetna used to be great to work with,” Ms. Colletti said. Since CVS Health acquired Aetna, she said, it has become “more corporate and less willing to work with ASCs.” Some regions still use Aetna’s legacy grouper, while many have moved to a percentage of Medicare, she said.
- Cigna: Cigna sold its Medicare business to Health Care Service Corp. in 2025. For commercial ASC contracts it uses a modified Medicare methodology, which it updates in late spring, she said. That means CPT codes added in January are paid at the contract’s default rate until the update. Unlike Medicare, Cigna does not pay the full rate for both neurostimulator generators and leads, she said.
- Blue Cross Blue Shield: “They operate more like a franchise,” Ms. Colletti said. She said methodologies differ by state, even among plans owned by Elevance Health.
United and Aetna “stick hardcore” to renewal timelines, Ms. Colletti said. “If you miss it by a day, come back six months later. They won’t work on a renewal.”
She also said payers often tie “Medicare-based” rates to a prior year’s fee schedule. A contract that appears to track Medicare may therefore not reflect current rates.
Some payers resist contracting at all in crowded markets, she said.
“They seem to have this mentality that if there are too many ASCs in the market, that’s too much for them to manage,” she said.
Contract rates are only part of the challenge. In a separate panel, Frank Phillips, MD, a spine surgeon at Chicago-based Midwest Orthopaedics at Rush, called the current climate “the most difficult payer environment I’ve seen in 25 years.”
Large private payers outsource utilization review to companies “incentivized by how much money they save the insurance company,” Dr. Phillips said.
“I’m doing a spine complex approval with a retired obstetrician in Atlanta,” he said of a peer-to-peer review. “That’s a real-life story.”
What ASCs can do
The presenters recommended that ASCs:
- Ask each payer which methodology it plans to use before starting a renewal.
- Track every renewal date in the business office.
- Model high-cost cases, such as multilevel fusions and spinal cord stimulators, under each payer’s methodology and push for carve-outs where the numbers fall short.
- Bring a value case to negotiations, such as a subspecialty or procedure no one else in the market offers.
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.
