Cardiology is shaping up to be the next big ASC specialty, following the path GI took in the 1990s and orthopedics in the 2010s. Medicare’s 2026 decision to pay for cardiac ablation in ASCs, a proposed 2027 rule that keeps widening the door and payer pressure on site-of-care have pushed cath and EP labs onto ASC leaders’ agendas.
Here are 10 things ASC leaders should know about cardiology’s move into the ambulatory setting:
1. CMS opened the door to ablation in 2026
In the 2026 OPPS/ASC final rule, published Nov. 21, 2025, CMS added cardiac catheter ablation codes to the ASC covered procedures list, alongside codes for percutaneous coronary interventions and vascular embolization or occlusion. The rule also eliminated five general exclusion criteria, recasting them as nonbinding physician considerations for patient safety.
In all, 560 codes were added to the list for 2026, according to the Ambulatory Surgery Center Association, which said it was especially pleased with the cardiac additions it pushed for alongside the Heart Rhythm Society and American College of Cardiology.
2. The 2027 rule would keep the list growing
CMS’ 2027 proposed rule, issued July 2, would remove 638 services from the inpatient-only list and pair the removal with another expansion of the ASC covered procedures list, giving physicians more room to shift cases to lower-cost settings. The rule also proposes a 2.4% ASC payment update. The final rule is expected this fall.
3. The specialty is small in ASCs but growing fast
Single-specialty cardiology ASCs grew from 55 in 2018 to 221 in 2023, about 4% of all Medicare-certified ASCs, and cardiovascular ASC volume is projected to grow 15% between 2023 and 2028, according to a JACC article.
The clinical groundwork is already in place. More than one-third of PCI patients now go home the same day, along with three-quarters of EP patients and 95% of AFib ablation patients, Braden Batkoff, MD, senior vice president at Constitution Surgery Alliance, said at Becker’s 31st Annual Business and Operations of ASCs Meeting in Chicago in 2025.
4. Payers want these cases out of the hospital
Many cardiac procedures carry high hospital overhead, which makes them prime targets for payers looking to cut costs, Andre Gauri, MD, chief quality officer of Corewell Health’s Heart and Vascular Institute, said on the same panel that year. He called electrophysiology, interventional cardiology and vascular surgery “really ripe for the ASCs.”
The price gap is wide. Coronary angiography catheter placement costs $382 at an ASC versus $919 at an HOPD, according to 2024 figures. CMS is also pushing site-neutral payment further: The 2027 proposed rule extends physician office rates to some imaging in off-campus hospital departments, a move that signals surgical services could be next.
5. Three ownership models are competing for cardiologists
Health system joint ventures are the most visible model. ChristianaCare, Cardiovascular Physicians of Delaware and Atlas Healthcare Partners are building a $9.3 million cardiovascular ASC in Newark, Del., and Penn Medicine partnered with Cardiology Consultants of Philadelphia on a $10 million ASC managed by SCA Health. Corewell Health’s joint venture with physicians and a management company works because “everyone has strengths,” Dr. Gauri said.
ASC management companies are partnering with independent physicians, as Compass Surgical Partners did with the Cardiovascular Surgical Institute of Northwest Florida.
Private equity is the third model. PE-backed platforms such as Cardiovascular Associates of America, US Heart and Vascular and Cardiovascular Logistics continue to expand through acquisitions and practice development. Larger platforms help capture migrating volume but raise questions about governance, compensation and physician autonomy.
6. Margins are tight, and capital costs are steep
ASC reimbursement for cardiac procedures often trails hospital outpatient rates by thousands of dollars per case. Average OR times for cardiology cases fell nearly 28% year over year, from 48 minutes to 34.7 minutes, but net revenue per case also fell about 8%, from roughly $5,014 to $4,611.
Margins may narrow further as operators face rising supply costs, staffing constraints and more frequent denials, with sustainability depending on strong payer contracting and tight device-cost management.
The upfront bill is large. Cath labs, imaging systems and recovery areas make it hard to overlay cardiology onto a multispecialty ASC, Vance Chunn, CEO of Mobile, Ala.-based Cardiology Associates, said. Recent projects bear that out: ChristianaCare’s two-lab center is budgeted at $9.3 million, and a proposed one-cath-lab ASC in Cookeville, Tenn., carried an $11.8 million price tag.
7. Not every patient, or every case, belongs in an ASC
“Not all patients are going to be right for the ASC,” Dr. Gauri said at Becker’s ASC meeting. “Not all AFib ablations, not all PCIs.” Heather Smith, director of cardiology at Ascension in Austin, Texas, said even well-screened patients bring “what-if moments,” so centers need to check home support and medication access before discharge.
Transparency is winning over skeptics. Centers that share their own complication rates, ambulance times and triage protocols are convincing physicians who were on the fence, Ms. Smith said. Dr. Batkoff said cardiology ASCs should deliver outcomes on par with or better than hospitals.
8. CON laws, staffing and capacity will slow the pace
State rules still decide where cardiology ASCs can open. Twelve states have no certificate-of-need program, and even where CON isn’t required, licensure rules for ablation and other complex cardiac procedures often lag behind CMS. Pennsylvania stands out as well positioned, with no CON law and licensure already updated for cardiac procedures in ASCs.
Tennessee shows how contested that ground remains. On Sept. 23, the state’s Health Facilities Commission voted 7-1 to deny a CON for Tennessee Heart’s proposed $11.8 million cardiac ASC in Cookeville. The nearby hospital argued the center would fragment care, and one commissioner warned a community hospital losing a third of its elective cardiology volume might have to close other services. The group plans to appeal.
Staffing is the other bottleneck. Recruiting and retaining cardiac nurses, cath lab techs and EP staff is proving difficult. Capacity is limited too: Corewell performed about 1,200 AFib ablations across four hospitals in 2024, a volume Dr. Gauri said cannot shift overnight given limited ASC lab capacity.
9. Recent openings and deals show who is moving
- In April, Colorado Springs Cardiology opened a heart and vascular ASC, the first of its kind in Southern Colorado and the largest ASC in the state.
- Also in April, ChristianaCare and Cardiovascular Physicians of Delaware formed a joint venture to open a nearly 9,000-square-foot cardiovascular ASC in Newark, Del., with two cath/EP labs, set to open in 2027.
- In January, Compass Surgical Partners and local physicians opened the two-cath-lab Cardiovascular Surgical Institute of Northwest Florida in Panama City.
- In 2025, Sentara Health teamed with Carient Heart & Vascular and Polaris Heart & Vascular Clinic to launch the Northern Virginia Heart & Vascular Center, the region’s first outpatient cardiovascular facility.
- Also in 2025, Penn Medicine and Cardiology Consultants of Philadelphia partnered on a $10 million, 13,100-square-foot cardiology ASC in King of Prussia, Pa., managed by SCA Health.
10. Expect purpose-built centers tied to health systems
Because cath labs are so expensive, cardiology is likely to enter ASCs mainly through single-specialty centers rather than multispecialty ones adding a lab. Larger health systems with both funding and a real ambulatory strategy are the ones getting in, Mr. Chunn said.
Dr. Batkoff urged organizations to build cardiology ASCs as integrated parts of their care systems rather than standalone facilities, noting a large share of cardiology will stay in the hospital. Still, he said physicians who make the move rarely go back. “Patients love it, physicians love it,” he said. “Cardiology is just getting started.”
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.
