CMS has approved electrophysiology ablation procedures for the ASC setting, marking a major advancement for outpatient cardiology and potentially accelerating the specialization of cardiac ASCs.
Medicare historically covered EP ablations only in hospital outpatient departments, driven by concerns about whether ASCs could safely support higher-acuity cardiac procedures.
Industry groups, including the American College of Cardiology and the Heart Rhythm Society, have long advocated for expanding the ASC-covered procedures list, arguing that advancements in technology, workflow and safety protocols have made more cardiovascular procedures feasible outside the hospital.
“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.”
Here are 10 things to know about EP ablation’s move into ASCs:
1. EP is positioned as interventional cardiology was before CMS’ 2020 shift
A scientific statement published by the Journal of the American College of Cardiology in November describes electrophysiology as the next specialty poised for site-of-care migration, similar to interventional cardiology’s path before CMS expanded ASC coverage for cardiac catheterization and percutaneous coronary intervention in 2020.
2. Same-day discharge is the operational bridge
The statement ties outpatient EP’s momentum to same-day discharge. Workflow improvements, including better imaging, vascular access management and newer energy sources, have made outpatient-style ablation care more realistic for selected patients.
3. Same-day discharge is already common in EP
A survey cited in the statement found about 90% of electrophysiologists currently perform same-day discharge for right-sided supraventricular tachycardia ablations, and more than three-quarters do so for a range of other EP procedures, aligning with discharge patterns seen in many ASC procedures.
4. Clinicians are confident in simpler cases, cautious on AF ablation
The survey showed about 80% of respondents believe right-sided SVT ablation could be safely performed in ASCs. But only about 50% believe AF ablation, left-sided SVT ablation, and right-sided premature ventricular contraction ablation belong in the ASC setting.
5. Outcomes data are strengthening the case
A multicenter U.S. study of ablations performed at six ASCs cited in the statement reported 0.45% urgent/unplanned hospitalization, no emergent cardiac/vascular surgery, and no increased risk compared with similar hospital cases performed by the same operators.
6. CMS already tested ASC-based ablation during COVID
CMS temporarily reimbursed intracardiac ablation procedures in ASCs during the COVID-era Hospitals Without Walls initiative, but that pathway did not become permanent afterward. The statement frames the pandemic period as an early proof of concept that helped build the feasibility case.
7. State regulation remains a major friction point
Even with CMS approval, adoption is expected to vary sharply by state. Certificate-of-need rules and cardiovascular restrictions shape ASC growth. New York, for example, prohibits cardiovascular services in ASCs and requires AF and VT ablations in facilities with on-site cardiothoracic surgical support.
8. Supporting procedures remain a major bottleneck
Even with ablation now ASC-eligible, key supporting services, including transesophageal echocardiography and cardioversion, are not on the ASC covered procedures list, according to the statement. Without those capabilities in the same setting, care pathways can become fragmented.
9. Cardiology ASCs are expanding quickly
Cardiology’s outpatient expansion is accelerating. In 2024 alone, 26 cardiology-focused ASCs were opened or announced, reflecting rapid growth in outpatient cath and EP capacity.
“Cardiology is now the big hot ticket for ASCs,” Bruce Feldman, administrator of Eastern Orange Ambulatory Surgery Center in Cornwall, N.Y., told Becker’s.
10. The race to add EPs has already begun
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.
Previously, the ASC had offered cardiovascular procedures under moderate sedation. Now, Ms. Tackett is coordinating anesthesia, supplies and staffing, adding that strong guidance from electrophysiologists has been key in organizing the service expansion.
