Electrophysiology (EP) is entering a new phase in the ASC setting. What was once limited to select cases is now expanding quickly, driven by Medicare policy updates, coding changes, and growing clinical confidence in performing complex cardiovascular procedures outside the hospital.
Comprehensive EP ablations now bring meaningful reimbursement into the ASC, and many centers are looking at cardiovascular service lines as a major growth engine. Success depends on how well an ASC understands the financial, logistical, and operational realities behind these cases and builds the infrastructure to support them.
Economic reality of EP in ASCs
Expanded eligibility for comprehensive EP ablations has accelerated the shift of these procedures into the ASC. Procedures once anchored in hospital outpatient departments are moving to surgery centers at a much faster pace, paving the way for higher-acuity cases and a broader role in cardiovascular care.
Implant and supply costs represent a significant portion of total case expenses, and they are not always reimbursed separately. Under the J8 payment methodology for device-intensive procedures, where device costs are built into the ASC rate, margin is highly dependent on supply management and cost visibility. Without a clear understanding of case-level costs, revenue growth can outpace margin.
Payer reality behind EP growth
Medicare has expanded coverage, but commercial payers frequently determine the financial ceiling. Coverage policies vary by payer, and contracts often lag new CPT codes and high-cost technologies, which can create gaps between expected and actual reimbursement. Delays are also common when new CPT codes have not yet been fully implemented in payer systems, making early denial tracking and escalation especially important. Assumptions carried over from hospital reimbursement can create additional challenges, particularly when physician coverage does not translate to ASC payment or when device expectations differ between settings.
Medicare non-payable does not necessarily mean commercially non-payable, making payer-specific verification essential. Without a clear understanding of payer requirements, even well-positioned ASC programs can see avoidable revenue disruption.
Most challenges come down to process gaps. Insurance verification may not flag non-payable scenarios before the procedure. Prior authorizations may not align with the CPT codes performed. Documentation may lack the specificity needed to support add-on codes or clearly distinguish between arrhythmia mechanisms. Device reporting can also be inconsistent, even though HCPCS codes are still required on the claim, even when those items are not separately reimbursed.
What high-performing ASCs do differently
High-performing centers approach EP with a level of discipline that reflects its requirements. Documentation is structured around CPT requirements from the outset, ensuring that each case supports the codes being billed. Add-on codes, +93655 (ablation) and +93657 (AFib), are supported by clear clinical detail, including distinct mechanisms and sequencing.
Case costing is embedded in operations. Leading ASCs analyze reimbursement alongside supply, implant, staffing, and overhead costs, modeling profitability by procedure, payer, and physician. Denial trends are monitored closely, and issues are escalated quickly. Clinical, operational, and financial teams stay aligned around both performance and outcomes, which supports more predictable results as volume grows.
A strategic decision: How will your ASC get paid?
As EP programs launch and expand, how an ASC structures its revenue cycle becomes critical. Some ASCs build internal teams, although experienced EP coding and billing resources are increasingly difficult to find. Others take a hybrid approach, keeping certain capabilities in-house while leveraging external expertise for more challenging functions (e.g., coding). There are also centers that move toward fully outsourced models, particularly when opening a new (de novo) ASC or scaling quickly.
Each model can work when it aligns with the organization’s needs. What matters is whether it can support device-intensive procedures, evolving payer policies, and detailed documentation requirements. As that complexity increases, many ASC leaders are reassessing whether their current infrastructure is built to keep pace.
Turning EP opportunity into margin
Cardiovascular care is continuing to move into ASCs, and EP will remain central to that shift. Medicare’s recent changes are likely to accelerate commercial payer adoption, bringing more opportunity to surgery centers prepared to manage both the clinical and financial complexity.
ASCs that succeed with EP — and cardiovascular services more broadly — will invest in cost visibility, payer strategy, and operational discipline from the outset. In a service line where reimbursement is meaningful but cost structures and payer variability are real, margin reflects how well that execution is managed.
John Lynch leads Surgical Information Systems‘ (SIS) operation in delivering revenue cycle management (RCM) solutions for clients, managing the growing SIS Revenue Cycle Services’ (RCS) team. He focuses on driving operational excellence, expanding services capabilities, and ensuring client success across SIS RCS, including billing and collections, coding, and transcription solutions. John has 20 years of professional experience in healthcare operations leadership and RCM.
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