CMS is moving a major share of complex procedures out of the inpatient-only bucket and into outpatient settings, a shift ASC leaders say could accelerate industry growth, especially in spine, orthopedics and cardiology.
In the 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule, published Nov. 21, CMS finalized a three-year phaseout of the inpatient-only list and will remove 285 primarily musculoskeletal procedures from the list in 2026.
“These new codes will empower our existing physician specialties to deliver high-quality care directly within our center, rather than in hospital outpatient department, or other traditional hospital healthcare settings,” John Petroni, managing partner of Las Vegas-based Silver State Surgery Center, told Becker’s. “This pivotal change not only enhances patient access to essential surgical services but also fosters a more streamlined and efficient care model, allowing patients to receive the treatment they need in a more comfortable and convenient environment. This will also significantly increase physician surgical scheduling efficiencies.”
CMS will also add 560 codes to the ASC covered procedure list, many requested by the Ambulatory Surgery Center Association. The additions include 289 procedures already paid in hospital outpatient departments and 271 procedures coming off the inpatient-only list. The newly covered services include cardiovascular codes for electrophysiology studies and ablations and percutaneous coronary intervention, as well as spinal codes such as posterior lumbar interbody fusion.
ASC leaders say these policy moves could reshape the field, from facility expansion to patient access and outcomes.
“The expansion of the ASC covered procedures list and phase-out of the inpatient-only list represent a fundamental redefinition of surgical care delivery,” Tracy Hoeft-Hoffmann, MSN, RN, administrator of Kearney, Neb.-based Heartland Surgery Center, told Becker’s. “Giving physicians discretion on site-of-service decisions will increase migration to ASCs, reduce patient costs and improve outcomes. These shifts will position ASCs as central to the future of surgical care.”
Other leaders agree. William Vanderveer, CEO of Matawan, N.J.-based Redefine Management, told Becker’s the addition “will drive serious growth to ASCs over the next five years.”
Scott Benko, administrator of Virginia Beach (Va.) Ambulatory Surgery Center, told Becker’s that he expected the addition of the procedures will result in rapid growth from cardiac catheterization labs and electrophysiology.
Outpatient cardiology is already gaining momentum. In 2022, 65% of outpatient peripheral vascular interventions in Medicare beneficiaries were performed in office-based laboratories, according to a JACC article published in July.The volume of cardiovascular services performed in ASCs is projected to grow 15% between 2023 and 2028.
Still, not all leaders view the update as sufficient. Some are urging CMS to eliminate the inpatient-only list entirely, rather than phasing it out.
“CMS reviewing procedures for ASC approval is a step in the right direction, but eliminating the inpatient-only list would truly expand access,” Sandra Germany, BSN, RN, administrator of Shreveport, La.-based Advanced Cardiovascular Specialists, told Becker’s. “The same procedures are often reimbursed at significantly higher rates in hospitals — shifting them to ASCs would reduce costs without compromising safety.”
Payment policy is another pressure point. CMS finalized a 2.6% ASC payment update for 2026 using the hospital market basket, mirroring the outpatient hospital update, and plans to continue that approach for now while monitoring effects. The ASC conversion factor for 2026 is $56.322, compared with $91.415 for hospital outpatient departments.
“The most important factor is the ASC covered procedures list. By approving the outward migration of more complex spine and orthopedic surgeries to ASCs, CMS is accelerating the shift to more cost-effective settings,” Shakeel Ahmed, MD. CEO of St. Louis-based Atlas Surgical Group, told Becker’s. “One urgent issue is payment updates — ASCs need inflation-adjusted reimbursement to remain sustainable as costs rise.”
