Cardiology is rapidly shifting to the outpatient setting, with CMS’ proposed 2026 payment rule adding more than 200 ASC-eligible procedures and paving the way for wider adoption of high-acuity cardiac care in ASCs.
Here are five cardiology procedures driving the shift:
1. EP ablations
The inclusion of electrophysiology ablation procedures marks a major advancement for cardiology. Industry groups like the American College of Cardiology and the Heart Rhythm Society have long advocated for this shift, and its approval could dramatically accelerate the specialization of cardiac ASCs.
“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. “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.”
2. Pacemaker and device implants
CMS’ update also includes pacemaker insertions, particularly leadless pacemaker systems, bolstering outpatient access to device-based cardiac care. Leadless technology, which eliminates the need for a chest incision and leads, can reduce complications such as infections and lead fractures.
3. Diagnostic catheterizations and low-risk interventions
Procedures such as diagnostic catheters, select percutaneous coronary interventions and device implants, were already approved for ASC use but are becoming increasingly important under CMS’ 2025 update as outpatient cardiology care expands.
These procedures will likely become the “bread and butter of ASCs,” Vance Chunn, CEO of Mobile, Ala.-based Cardiology Associates, told Becker’s.
4. Peripheral vascular interventions
Procedures like peripheral vascular stenting are migrating as hybrid ASC–office-based models emerge. Complex reimbursement and regulatory structures mean some facilities pivot between settings depending on payer coverage.
5. Loss: Coronary lithotripsy and diagnostic peripheral angiography
Despite advocacy, CMS has yet to include coronary lithotripsy or diagnostic peripheral angiography in the ASC CPL.
“I was surprised that they did not fix an error that was made last year, when they removed coronary lithotripsy. This proposed rule was released without putting it back on the proposed list. The procedure was being done with high levels of safety and efficiency for patients,” Mr. Helmer told Becker’s.
