The ASC Reimbursement Tracker
A standing reference: the CY2026 update, the conversion-factor gap, and national rates for the sector's marquee codes. Updated with our reimbursement coverage.
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Reimbursement
Tracking the conversion factor, payer behavior, and the long-running parity gap between ASCs and hospital outpatient departments.
Edited by Brent Reilly · 2 reporters · Updated continuously
- UnitedHealthcare ends GI site-of-service review Oct. 1 — the friction it drops sat on hospitals, not ASCs
A UnitedHealthcare notice posted September 1 stops advance notification for EGD, capsule endoscopy and diagnostic and surveillance colonoscopy from October 1 — and in the same paragraph ends site-of-service medical-necessity review, which the payer conditioned on the outpatient hospital setting.
Why it matters: Site-of-service review exists to make the costlier setting justify itself, and UnitedHealthcare conditioned it on the hospital outpatient department — so retiring it for GI removes an administrative edge ASCs held rather than handing centers relief. - Year two of the inpatient-only phase-out proposes 637 more services — and skips musculoskeletal
The CY2027 OPPS/ASC proposed rule would remove 637 services from Medicare's inpatient-only list across eleven clinical families. Orthopedics, which dominated year one's 285 removals, is not among them.
Why it matters: If your 2027 growth case assumes the inpatient-only phase-out keeps feeding orthopedics, the proposed second year points somewhere else entirely. - 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. - 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. - Where ASC payment actually stands in 2026 — and what's queued for 2027
A 2.6% update, 547 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. - 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.