The Centers for Medicare and Medicaid Services added 573 procedures to the ASC covered procedures list for 2026 — 302 newly approved codes and 271 coming off the inpatient-only list. For the Ambulatory Surgery Center Association, which spent years in active dialogue with cardiac specialty groups to build the safety data case for higher-acuity cardiovascular procedures, the expansion represents the largest single-year shift in site-of-service policy the industry has seen.
It is also, by the association’s own account, incomplete.
“ASCA expects CMS to finalize the addition of a large number of procedures to the ASC-CPL for 2026,” Kara Newbury, the association’s chief advocacy officer, told Becker’s in November 2025. “Increases in staffing and anesthesia costs threaten to limit the migration of more services to the ASC setting if reimbursement does not keep pace.”
That gap — between what CMS has approved and what ASC leaders believe is clinically and financially viable in the ambulatory setting — shows up most clearly in cardiology, where the 2026 expansion approved cardiac catheter ablation but left the supporting infrastructure incomplete.
Cardiac catheter ablation was among the most celebrated additions to the 2026 list, representing years of advocacy from the American College of Cardiology and the Heart Rhythm Society. “The addition of EP ablation is a big win for cardiology,” Tracy Helmer, administrator of Mesa, Ariz.-based Tri-City Surgical Centers, told Becker’s in July 2025, just after the rule release. “There’s been a lot of work with that over the last number of years to show the efficacy and safety profile for those particular procedures.”
But Helmer also flagged what didn’t move. “I was surprised that they did not fix an error that was made last year, when they removed coronary lithotripsy,” he told Becker’s. “The other procedure that is keeping many patients out of the ASC setting is diagnostic peripheral angiography, being that the only way a patient can get this type of procedure is if they have an intervention done.”
Even with ablation now ASC-eligible, key supporting services — including transesophageal echocardiography and cardioversion — remain off the covered procedures list, according to a scientific statement published by the Journal of the American College of Cardiology and reported by Becker’s. Without those capabilities in the same setting, care pathways can become fragmented, limiting the practical value of the ablation approval for centers that cannot offer the full procedural environment, according to the report.
SCA Health leaders told Becker’s that while the cardiovascular expansion is directionally significant, adoption will depend heavily on geography, physician alignment and facility readiness — and that volume will not shift immediately. New York state prohibits cardiovascular services in ASCs entirely and requires atrial fibrillation and ventricular tachycardia ablations in facilities with on-site cardiothoracic surgical support, per Becker’s reporting. Other states with certificate-of-need laws will move more slowly regardless of what CMS approves at the federal level.
The orthopedic and spine specialties are watching a different set of procedures. The 168 orthopedic codes added to the ASC covered procedures list in early 2026 brought high-complexity musculoskeletal cases. An analysis of KNG Health data published by ASCA in May projects that musculoskeletal surgeries performed in ASCs will generate $13.5 billion in Medicare fee-for-service savings from 2025 to 2034 — making orthopedics the second-largest specialty by program savings. Cardiovascular cases are projected to see the steepest growth over the same period, with savings rising more than 300% as newly approved cardiac procedures migrate out of HOPDs, according to the analysis. Medicare pays ASCs roughly half what it pays hospital outpatient departments for the same procedure, making each additional code moved to the ASC list a compounding savings mechanism for the program.
CMS is eliminating the inpatient-only list entirely by Jan. 1, 2029, giving advocacy efforts a structural deadline. The reimbursement gap is the variable that could slow migration regardless of what gets approved. The ASC conversion factor for 2026 stands at $56.322, compared with $91.415 for HOPDs — a disparity that persists even as both settings receive the same market basket update.
ASCA has asked CMS to stop applying a secondary weight scalar that effectively widens the gap over time, and a bill introduced in March would make the hospital market basket update for ASCs permanent and eliminate the ASC-specific budget-neutrality adjustment that pulls rates down when aggregate spending rises.
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.