CMS has cleared the federal path for cardiology’s move into ASCs, adding cardiac catheter ablation and hundreds of other cardiovascular codes to the ASC covered procedures list, starting in 2026. But whether a center can actually perform those procedures still comes down to state law, and that picture varies widely. Here’s a tiered look at which states are furthest along.
Tier 1: No certificate-of-need law, clearest runway
Twelve states have no CON program at all, meaning ASCs can typically add a cardiovascular service line without state approval standing between them and CMS’ new coverage. Becker’s tracks the full state-by-state CON list annually:
- Texas
- California
- Pennsylvania
- Colorado
- Utah
- Idaho
- Wyoming
- New Mexico
- North Dakota
- South Dakota
- Kansas
- New Hampshire
Arizona, Minnesota and Wisconsin have only a limited version of CON and largely belong in this tier too.
Tier 2: CON law in place, but with cardiac- or ASC-specific carve-outs
These states still require a certificate of need generally, but have created exemptions that ease the path for cardiovascular ASCs specifically. This tier draws on Becker’s coverage of the CON shakeup:
- South Carolina — repealed its entire CON program in 2023, except for nursing homes
- Georgia — exempts certain single-specialty ASCs from CON review if they are owned by a single physician or practice and stay under set capital and operating-room thresholds
- North Carolina — exempted ASCs in counties over 125,000 people from CON review starting in 2023, ahead of a broader repeal effort that Becker’s has reported is now tied up in legal challenges
- Tennessee — passed a repeal of CON for acute care hospitals in April 2026, to be phased in through 2030
Tier 3: Licensure already updated for cardiac procedures in the ASC setting
CON isn’t the only gate. Even where state approval isn’t required, facility-licensure and scope-of-practice rules for performing ablation and other complex cardiac procedures in an ASC often lag behind CMS’ coverage decision. According to Stephen Abresch, director of government affairs at the Ambulatory Surgery Center Association, only a handful of states have actually updated their licensure rules to allow it, years after CMS first added PCI codes to the covered list:
- Mississippi
- Michigan
- Pennsylvania — notable for appearing in both Tier 1 and Tier 3, giving it arguably the clearest combined path of any state
The bottom line
Pennsylvania stands out as the best-positioned state overall, combining no CON law with licensure already updated for cardiac procedures in ASCs. Texas and the other CON-free states offer the fastest regulatory runway but haven’t all confirmed updated licensure for the newest procedures. States in Tier 2 show the clearest momentum for reform, even if they haven’t fully caught up. Becker’s has reported that nearly half of states with CON laws have signaled plans to loosen or repeal them, suggesting this list will keep shifting.
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.
