Where ASC payment actually stands in 2026 — and what's queued for 2027
The CY2026 final rule gave ASCs their broadest procedure-list expansion in years while holding the update at 2.6%. The CY2027 proposed rule — expected this summer — and a new House parity bill will decide whether the momentum compounds.
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- CMS finalized a 2.6% CY2026 ASC update — the 3.3% hospital market basket minus a 0.7-point productivity adjustment — identical to the hospital outpatient update.
- 560 procedures joined the ASC covered list: 289 from revised criteria plus 271 coming off the inpatient-only list, which begins a three-year phase-out.
- The payment gap remains structural: the ASC conversion factor is $56.32 against $90.97 for hospital outpatient departments, per MedPAC.
- H.R. 8091, the Outpatient Surgery Access Act of 2026, would align ASC updates with HOPDs starting in 2027 and strip ASC-specific budget-neutrality adjustments.
- Watch the CY2027 proposed rule (expected ~July): CMS has signaled a larger 340B offset and will fold in its drug acquisition cost survey.
Ambulatory surgery centers entered 2026 with the most consequential payment rule in years. The CY2026 OPPS/ASC final rule, finalized November 21 and effective January 1, set the ASC update at 2.6% — the 3.3% hospital market basket minus a 0.7-percentage-point productivity adjustment — and, more importantly, rewrote what ASCs are allowed to do.
The list got longer. A lot longer.
CMS revised its covered-procedures criteria, downgrading five general exclusions to nonbinding “physician considerations,” and added 289 procedures to the ASC covered list. On top of that, the agency began a three-year phase-out of the inpatient-only list, removing 285 mostly musculoskeletal codes for 2026 and adding 271 of them — including total hip revisions and a slate of spinal procedures — directly to the ASC list. That’s 560 new covered procedures in one rule, with cardiac catheter ablation among the additions.
CMS projects roughly $9.2 billion in total ASC payments for CY2026, per the rule’s estimates summarized by McDermott+.
The gap is the policy
The structural arithmetic hasn’t moved: MedPAC’s March 2026 report puts the ASC conversion factor at $56.32 against $90.97 under the OPPS — ASCs are paid materially less for the same service, which is exactly why payers keep steering volume toward them. The commission’s standing recommendation isn’t a raise; it’s that Congress require ASCs to submit cost data, without which no one can say what adequate payment is.
Congress has the parity question in front of it. H.R. 8091, the Outpatient Surgery Access Act of 2026, introduced in March by Reps. Beth Van Duyne and John Larson, would align ASC annual updates with hospital outpatient departments starting in 2027 and eliminate ASC-specific budget-neutrality adjustments. It is ASCA-endorsed and bipartisan; it has not moved past introduction.
What to model for 2027
The CY2027 proposed rule has not been published; the annual cycle points to July (the CY2026 version arrived July 17, 2025). Two signals from the current rule are worth budgeting against now. First, CMS kept the 340B-related offset at 0.5% for 2026 but wrote that it anticipates “a larger reduction (such as 2 percent)” beginning in CY2027. Second, the agency’s drug acquisition cost survey is timed to inform CY2027 policymaking — a wildcard for any center with meaningful drug spend.
Run your 2027 case-mix model both ways: current methodology, and H.R. 8091’s parity formula. The gap between those two numbers is what this year’s policy fights are worth to your center.