- DOJ's proposed OhioHealth judgment voids the contract clauses that block steering to ASCs
A proposed final judgment filed in the Southern District of Ohio would wipe out OhioHealth's anti-steering and transparency restrictions and install a five-year monitor; the government's competitive impact statement names the ambulatory surgery center as the lower-cost site payers were kept from steering to.
Why it matters: The clauses that stop a payer from pointing members at a cheaper site are now antitrust exposure rather than a negotiating position — and the filing is a public map of the contract language the Justice Department considers illegal. - Surgery Partners agrees to sell its Idaho Falls hospitals to Intermountain for ~$795M
Surgery Partners signed definitive agreements to sell its stakes in two Idaho Falls surgical facilities to Intermountain Health, a deal valuing the facilities at about $1.15 billion and sending roughly $795 million to the ASC operator.
Why it matters: The sale turns Surgery Partners' two largest hospital assets into cash — roughly $795 million in consideration, though the company has not yet pegged net proceeds — and a simpler, ASC-weighted portfolio, just as it heads into a back half in which it has said it intends to spend on acquisitions. - CMS proposes a 2.4% CY2027 ASC update and 618 more covered procedures — comments close August 31
The CY2027 OPPS/ASC proposed rule sets the ASC update at 2.4%, extends the hospital-market-basket update formula one more year, and proposes adding 618 codes to the covered-procedures list. Published July 7; comments due August 31.
Why it matters: This rule sets the starting point for every 2027 ASC budget line — the annual update, the payment formula, and which procedures Medicare will pay an ASC to perform. The comment window is the only lever operators have before it's final. - CMS's new open-data release gives ASCs a HOPD benchmark — but no ASC dataset
An April 6 Federal Register notice releases seven Original Medicare and Medicaid provider-and-service datasets, including hospital outpatient utilization and payment — and none of them is ASC-specific.
Why it matters: The release lets ASC operators benchmark their case mix against named hospital outpatient departments, but it adds no new data on ASCs themselves. - The cardiology societies signed off on ASC ablation — and that's the part that de-risks the build
A July 29, 2025 HRS comment letter told CMS that same-day-discharge ablation is safe in appropriately selected patients — the endorsement that lets an electrophysiologist clear a medical-staff and payer review before the first $20,256 case.
Why it matters: An operator weighing an EP line now has a primary-source society endorsement to cite against medical-staff and payer objections — the soft barrier that usually kills new ASC service lines before the capital question is even reached. - Lumbar fusion codes 22630 and 22633 land on the ASC list for 2026 — five years after CMS first opened, then shut, the door
The CY2026 final rule adds posterior lumbar interbody fusion (22630) and combined PLIF (22633) to the ASC covered-procedures list — instrumented spine work CMS first cleared toward outpatient settings in 2021 and walked back in 2022.
Why it matters: Spine-heavy centers can now bill Medicare for instrumented lumbar fusion — a far higher-revenue, higher-implant-cost line than the decompressions ASCs already run. - Surgery Partners spent $4M on deals in Q1 against a $200M-a-year pace
The ASC roll-up deployed $4.2 million on acquisitions in the first quarter — roughly 2% of its ~$200 million annual target — leaving most of a year's dealmaking still to come.
Why it matters: A serial buyer this far behind its own deployment pace enters the back half of 2026 needing to put capital to work, which tends to firm pricing for sellers. - USPI booked half its 2026 deal budget in Q1 — and the math caps what sellers can ask
Tenet's ASC arm spent $125 million buying seven surgery centers in the first quarter, half its $250 million annual target, while telling investors a de novo costs under 2x what an acquisition runs at 8–10x.
Why it matters: The sector's largest strategic buyer can build a center for a fraction of what it pays to buy one, and that build-vs-buy gap caps independent ASC exit valuations. - The 2026 ASC valuation gap: single centers fetch 5x-8x, platforms 11x-17x
FOCUS Investment Bankers' April 2026 benchmarks put single-specialty ASCs at roughly 5x-8x EBITDA and regional or national operators at 11x-17x — a gap that decides whether an owner sells a center or builds a platform.
- ChristianaCare puts cath, ablation and device implants into a $9.3M cardiovascular ASC
A three-way joint venture will build a 9,000-square-foot cardiovascular surgery center in Newark, Delaware, projecting roughly 10,800 outpatient heart and vascular procedures a year in New Castle County by 2029.
Why it matters: This is one of the first hospital-plus-physician cardiovascular ASCs to name and size the exact procedure mix — including ablation — that CMS opened to surgery centers in the CY2026 final rule, so operators weighing a de novo cardiac center now have a concrete comparable to model against. - Arizona-based shell raises $21M to buy ASCs, SEC filing shows
A purpose-named acquisition vehicle, Ambulatory Surgery Center Acquisition HoldCo, has sold $21.0 million of a $22.6 million offering to 27 investors, per a June 11 SEC amendment.
Why it matters: A datable pool of new buy-side capital is forming outside the THC/SCA/Optum majors — independent ASC owners weighing a sale now have one more bidder at the down-market table. - Connecticut rewrites its CON program: OHS's review power moves to DPH, with a new 3-member panel
Public Act 26-68, signed May 26, makes the Department of Public Health the successor to the Office of Health Strategy for certificate-of-need review, stands up a three-member CON panel, and adds a relocation carve-out and a two-to-three-OR expedited path.
Why it matters: An independent CT surgery center can now relocate within its town or 10 miles without a CON, and ask for an expedited two-to-three-OR add — while a hospital's satellite outpatient surgery site is pulled squarely under CON as a health care facility. - Anthem to dock NY facilities 7.5% of the claim for out-of-network care, starting July 1
Anthem's New York provider bulletin sets a July 1, 2026 penalty of 7.5% of the allowed amount of a participating facility's claim whenever a nonparticipating provider renders part of the care.
Why it matters: ASCs that rely on out-of-network anesthesiologists, radiologists, or pathologists now lose 7.5% of the facility claim on every affected case unless they bring those providers in-network. - Aetna cuts the CT technical component 15% on Sept. 1 — and it reaches OPPS, not just the fee schedule
Aetna's June 2026 OfficeLink Updates set a 15% reduction to the technical component of CT services billed with modifier CT, effective September 1, 2026, applied across both the physician fee schedule and OPPS for commercial and Medicare members.
Why it matters: Imaging-equipped centers running a CT scanner that fails the NEMA XR 29-2013 Smart Dose standard take a 15% line-item cut on the technical component starting September 1 — making the upgrade-or-eat-it call a Q3 capex question. - Mississippi doubles its Certificate-of-Need dollar thresholds
HB 3, approved by Gov. Tate Reeves on February 4, raises the major-medical-equipment CON trigger from $1.5M to $3M and the capital-expenditure trigger from $5M to $10M.
Why it matters: An equipment buy up to $3M — or a clinical build-out under $10M — now clears below the new caps without a CON application, removing a months-long review from expansion and equipment timelines (a brand-new ASC still needs a CON for the service line itself). - The ASC Reimbursement Tracker
Medicare ASC rates for the procedures that drive center economics, straight from the CMS addenda — with the policy changes that move them.
Why it matters: Payment updates compound. Knowing which codes moved — and modeling them against your case mix — is the difference between a budget and a guess. - Where ASC payment actually stands in 2026 — and what's queued for 2027
A 2.6% update, 560 procedures added to the covered list, the inpatient-only list phasing out, and a payment-parity bill in the House: the CY2026 rule reset the board.
Why it matters: Every line in your 2027 budget — rates, case mix, payer steering — traces back to decisions CMS finalized in this rule or queued for the next one. - Ascension closes AMSURG deal as FTC carves out seven centers — six go to Optum
The $3.9 billion acquisition closed June 4 under an FTC consent order requiring divestitures in five markets, with Optum's SCA Health buying six of the seven divested centers.
Why it matters: The two largest nonprofit-and-payer consolidators just got bigger in the same transaction — independent centers in overlap markets now negotiate against deeper networks on both sides. - Q1 splits the market: USPI adds facilities while HCA's outpatient surgeries slip
Tenet's ambulatory arm grew adjusted EBITDA 6.1% and added 10 facilities in the quarter; HCA's same-facility outpatient surgeries fell 1.7%.
Why it matters: Surgical volume isn't disappearing — it's changing buildings. Where it lands is the whole game for operators, payers, and sellers weighing valuations. - Total joints keep moving: Medicare TKA volume in ASCs rose 27.6% in 2024
MedPAC's March report counts 49,258 total knee replacements in ASCs in 2024 — up from roughly 10,800 in 2020, the year Medicare first covered the procedure there.
Why it matters: Joint volume is the highest-revenue migration in the sector — capacity, block time, and payer contracting decisions made this year determine who captures it. - Medicare ASC spending jumped 13% to $7.5B in 2024, MedPAC reports
The commission's March 2026 report counts 6,436 Medicare-certified ASCs — a net 140 more than 2023 — treating 3.4 million beneficiaries across 6.4 million services.
Why it matters: Spending growing nearly six times faster than facility count means revenue per center is climbing — the strongest simple signal in the sector's favor. - CMS turns on prior authorization for ASC services in 10 states
A five-year Medicare demonstration now requires prior authorization for five service categories — including vein ablation and blepharoplasty — with claims subject to prepayment review if centers opt out.
Why it matters: Traditional Medicare has been the no-prior-auth refuge; this demonstration is the template for ending that, and affected centers need a request workflow now. - Payers are cutting prior auth — and pointing the freed-up volume at ASCs
UnitedHealthcare is eliminating authorization for 30% of services that required it; commercial site-of-care programs increasingly waive review for ambulatory surgery centers while keeping it on hospital outpatient departments.
Why it matters: Site-of-care steering is becoming the default commercial posture — centers that make scheduling easy capture the redirected cases.