CMS issued its final policy changes for Medicare payments under the Physician Fee Schedule Oct. 31, alongside other updates to Medicare policy.
ASC leaders had feared that the update may be delayed amid the ongoing federal shutdown, which has caused other delays and disruptions across healthcare. However, the announcement did not include updates to several other key ASC policy proposals, including a proposed expansion of the ASC covered-procedures list, the ASC Quality Reporting Program or the Hospital Outpatient Prospective Payment System rule.
Kara Newbury, chief advocacy officer of the Ambulatory Surgery Center Association, joined Becker’s to discuss the rule finalization and when ASCs can expect further updates.
1. This year, the MPFS was released ahead of the rest of CMS’ final rules for 2026. Is this something we have seen before? It is often the case that the Medicare Physician Fee Schedule final rule is released in advance of the OPPS/ASC final rule. Typically when that happens, though, it is only a day or two in advance. There are some ASC codes, office-based codes, for which reimbursement is based on the MPFS rates. Therefore, CMS needs to have the MPFS established either earlier or at the same time as our rule.
2. Any insights as to when the other updates, such as the OPPS and CPL will be finalized/released? The OPPS/ASC rule has still not cleared its final review according to the [Office of Management and Budget] dashboard. Typically, rules appear there prior to being included in the Federal Register, although with the MPFS release last week, both appeared at the same time. We are hoping that the final rule will be released soon to allow our facilities time to adjust to any significant changes, such as the addition of new procedures to the ASC-CPL.
3. Any other predictions or thoughts as to how ASCs should respond in these uncertain times? ASCA expects CMS to finalize the addition of a large number of procedures to the ASC-CPL for 2026. ASCA knows, however, that more work needs to be done to ensure that the reimbursement keeps pace with rising costs. While our facilities are efficient, increases in staffing and anesthesia costs threaten to limit the migration of more services to the ASC setting if reimbursement does not keep pace.
