In November, CMS finalized plans to add 560 codes to the ASC covered procedure list — a change expected to accelerate service line expansion and development activity across the ASC industry.
At the same time, CMS finalized a three-year phaseout of the inpatient-only list and will remove 285 primarily musculoskeletal procedures from the list in 2026.
For many centers, the regulatory shift signals more procedures, more patient volume and the potential to capture cases that previously had to remain in hospital outpatient departments or inpatient settings.
Industry leaders warn that expansion must be calculated, not rushed, particularly as centers navigate rising labor costs, tighter margins and infrastructure constraints.
Tina DiMarino, CEO of Custom Surgical Partners, an ASC company that has developed more than 150 centers, told Becker’s that the move will be the biggest opportunity for growth in the ASC industry in 2026.
“The expansion of approved procedures is huge — especially cardiac and orthopedic cases,” she said. “New CMS codes coming into the ASC space allow both existing and new centers to grow by pulling cases out of inpatient and HOPD settings.”
The opportunity lies in leaning into existing specialties while also expanding into new areas where demand and operational capacity align, she said.
But while enthusiasm is high, Ms. DiMarino cautioned that long-term success will depend on ensuring each center is expanding in the right market, with the right staffing and the right infrastructure.
“Development activity has gone through the roof, and it’s clear that ASCs are seen as the future — but centers still need to be mindful of location, staffing availability and infrastructure,” Ms. DiMarino said.
That warning is especially relevant in cardiology — one of the high-acuity specialties expected to expand in the ASC setting — because it often requires significant upfront investment, new staffing competencies and advanced equipment.
Kristen Richards, vice president of ambulatory care at Cardiovascular Logistics, told Becker’s that the cost of setting up a cardiovascular ASC is steep because of equipment complexity, and that outfitting a single room can cost well over $1.5 million.
“Supply costs are high in cardiovascular care — stents, devices, defibrillators, pacemakers — they all add up,” she added.
Leaders emphasized that centers should start with a clear financial picture before moving forward on any new service line, from major specialty additions to smaller procedure expansions. That includes an honest assessment of not only capital costs, but also ongoing staffing, training and supply expenses.
“Do your homework. Use a detailed financial plan and a practical assessment. Analyze the plan and determine if the new service line or expansion will deliver a return on investment,” Ms. DiMarino told Becker’s in October. “This means getting realistic estimates of patient volume and the revenue those cases will bring in. In addition, understand all the associated costs.”
Beyond financial planning, expansion also depends on whether centers can recruit and retain clinical teams with the skills to safely support higher-acuity cases.Thomas Jeneby, MD, a plastic surgeon in San Antonio, told Becker’s that assembling a flexible and communicative team of physicians and nurses is of the utmost importance when expanding service lines.
“What is the temperament of the new physicians? Are they ‘needy’ with a ton of requests for expensive equipment or supplies? Do you have a nurse or tech that has done these before (ask around – you would be surprised)?” he said. “The recovery of these patients — are there nuances to it? Again — [do] any nurses have experience with those types of patients? Hire a champion part-time if not. How long is that doctor going to operate there so you can pay back the equipment cost? Can you rent or have vendors bring them in? Beware the ‘jumping’ surgeon or physician who leaves the surgi-center over the slightest issue!”
Charleen Tackett, administrator of Houston-based Vital Heart & Vein, told Becker’s that the delay in the final approval of new procedures has resulted in a “mad dash” to safely pull together the equipment and staff necessary to add EP ablations, one of the procedures recently approved by CMS.
“We’re a cardiology practice, so we’re lucky to have our EP physicians here with us to guide us on equipment that they prefer,” she said. “I think if you’re trying to bring in cardiology, not having them there to readily help you could be a barrier.”
For any ASC looking to add or expand into cardiology, and especially for those adding EP ablations, Ms. Tackett said centers should build a development team that can oversee every moving piece, from supply chain needs and clinical staffing to safety protocols and quality systems.
That includes staffing for a high-risk population that differs significantly from the standard ASC patient, leaders said. Tracy Helmer, administrator of Mesa, Ariz.-based Tri-City Surgical Centers, told Becker’s in 2024 that cardiology requires more specialized personnel and workflows than many centers may be accustomed to.
“The biggest thing I can advise is that people wanting to venture into cardiology need to know this is a critical care specialty. It requires critically trained techs, nurses and practitioners who are familiar with the risks, technology and treatments involved,” he said. “These may not be present in the standard ASC patient. Things like screening patients differently and having well-trained cardiac rad techs and heart techs are key. You can’t put a surgery tech in a catheterization lab or a cardiology case and expect them not to feel uncomfortable.”
