CMS proposes a 2.4% CY2027 ASC update and 618 more covered procedures — comments close August 31
The biggest reimbursement day of the year landed July 7. CMS proposes a slightly smaller update than CY2026 but keeps the hospital-market-basket formula ASCs have been asking to make permanent — and proposes an even larger covered-list expansion than last year's rule.
Stories like this run in the free briefing. Get the next one →
- CMS proposes a 2.4% CY2027 ASC payment update for centers that meet ASCQR quality reporting — a 3.2% hospital market basket minus a 0.8-percentage-point productivity adjustment.
- That is a step down from the 2.6% finalized for CY2026 (3.3% market basket minus 0.7 points), driven by a lower market basket and a larger productivity cut.
- CMS proposes extending the hospital market basket as the ASC update factor for one more year, through CY2027 — the formula ASCs have long argued should be permanent.
- The rule proposes adding 618 codes to the ASC covered-procedures list, continuing the list expansion that reshaped the CY2026 rule.
- Comments are due August 31, 2026; the final rule typically lands in November.
The reimbursement year turns on two rules, and the first one is out. CMS published the CY2027 OPPS/ASC proposed rule (CMS-1850-P) in the Federal Register on July 7. It proposes the CY2027 ASC payment update, keeps the payment formula ASCs have pushed to make permanent, and proposes an even larger addition to the covered-procedures list than last year’s rule. Comments are due August 31.
The update: 2.4%, a notch below last year
CMS proposes to raise ASC payment rates by 2.4% for centers that meet the ASCQR Program’s quality-reporting requirements. The rule states it plainly: “for CY 2027, we are increasing payment rates under the ASC payment system by 2.4 percent for ASCs that meet the quality reporting requirements under the ASCQR Program. This increase is based on a proposed hospital market basket percentage increase of 3.2 percent reduced by a final productivity adjustment of 0.8 percentage point.”
That is a step down from CY2026. The CY2026 final rule set the update at 2.6% — “a final hospital market basket percentage increase of 3.3 percent reduced by a final productivity adjustment of 0.7 percentage point.” Both moving parts pushed the number down for 2027: a lower market basket (3.2% vs. 3.3%) and a larger productivity cut (0.8 vs. 0.7 points). The two-tenths difference is small in isolation, but it compounds across a full year of Medicare volume — and it is the starting figure, subject to change before the final rule.
The formula holds — for one more year
The more consequential line for anyone modeling past 2027 is that CMS proposes to keep using the hospital market basket to update ASC rates. The rule says CMS is “extending our utilization of the hospital market basket update as the update factor for the ASC payment system for one additional year (through CY 2027).”
This is not a new policy — it is a renewal. The CY2026 final rule records that CMS “adopted a policy to update the ASC payment system using the hospital market basket update” for CYs 2019 through 2023, and has since extended it a year at a time. The words doing the work are “one additional year.” CMS is renewing the policy, not making it permanent, so the structural update question is deferred again, not resolved — which is why the sector wants the hospital-market-basket update locked in rather than renewed annually at CMS’s discretion. That is precisely the fight H.R. 8091, the Outpatient Surgery Access Act of 2026, would settle by statute; the bill has not moved since its March referral.
The list keeps growing
CMS proposes to “continue to expand the ASC covered procedures list (CPL) by adding 618 codes to the ASC CPL.” That extends the covered-list expansion that defined the CY2026 rule, which added 547 procedures — 276 on revised clinical criteria and 271 codes coming off the inpatient-only list. Every code added to the CPL is a procedure Medicare will pay an ASC to perform — the mechanism by which higher-acuity cardiology, spine, and orthopedic work has been migrating out of hospitals.
The proposed total is a headline number, not a case-mix plan. Which specific code families are in the 618 — and whether any carry the implant and device-offset economics that make a procedure worth adding as a service line — has to be read off the rule’s addenda before it means anything to a given center. What the total signals is direction: CMS is still opening the list, not pausing it.
What to do before August 31
The comment window is the only point of leverage before these numbers harden into the final rule. Three things are worth pressure-testing against your own data now:
- The update. 2.4% is a proposal. The market basket and productivity figures are explicitly labeled as proposed and can shift before the final rule.
- The formula extension. If the hospital-market-basket update expiring after CY2027 matters to your multi-year model, the comment window is where the sector argues to keep it — or make it permanent.
- The covered list. Confirm which of the 618 proposed codes intersect your specialties, and price the ones that do against the 24-hour ASC recovery constraint and their implant costs before treating them as revenue.
The CY2026 final rule published November 25 last year; the CY2027 final rule should follow a similar timeline. The proposed rule is where the number starts. The comment you file, or don’t, is what moves it.