ASCA Demands That CMS Address ASC Payment Cuts in 2027 Proposed Rule
Alexandria, VA—The Ambulatory Surgery Center Association submitted comments to the Centers for Medicare & Medicaid Services on proposed 2027 updates to the ASC payment system. In its comments, ASCA supported provisions aimed at expanding the range of procedures performed in ASCs but warned that declining reimbursement for many high-volume procedures will prevent Medicare beneficiaries from fully benefiting from care in the lower-cost setting.
“Adding more procedures to the ASC Covered Procedures List is a positive step, but a failure to address the urgent payment issues will trap patient volume in more expensive settings and needlessly increase costs for the Medicare program,” said Bill Prentice, ASCA CEO.
ASCA called for several changes to the proposed 2027 ASC payment updates.
Eliminate the ASC Weight Scalar
ASCA’s primary payment recommendation is that CMS discontinue the ASC weight scalar, which is projected to cut payments for 85 of the top 100 ASC procedures by Medicare volume in 2027.
Impact of Proposed Changes on Cardiovascular Procedures*
Cardiovascular procedures are particularly affected by CMS’ policies for device-intensive services. CMS estimates that aggregate Medicare payments for cardiovascular procedures performed in ASCs would increase 5% in 2027, compared with a 2% increase across ASC services overall, reflecting the relatively high proportion of device-intensive procedures in cardiovascular care. At the same time, CMS proposes reducing the ASC weight scalar from 0.872 in 2026 to 0.809 in 2027. ASCA called the proposed change the largest projected cut to ASC weights since 2008 and is urging CMS to eliminate the scalar altogether.
Permanently Align ASC and Hospital Inflation Updates
ASCA supported CMS’ proposal to continue using the hospital market basket as the annual update mechanism for ASC payments and urged the agency to make the policy permanent. Recent research shows that using the same update factor for hospitals and ASCs has encouraged procedures to migrate to the lower-cost ASC environment and increased Medicare program savings.
Improve Rural Payment Equity
ASCA urged CMS to extend existing hospital wage-index protections to ASCs. Surgery centers face the same workforce challenges as hospitals but are not permitted to benefit from geographic reclassification policies or frontier-state wage-index floors. Expanding those policies to ASCs would help rural facilities remain financially viable and improve access to outpatient surgical services in underserved communities.
Allow Billing for Unlisted Procedure Codes
The association asked CMS to grant ASCs the same permission as hospitals and physician offices to receive reimbursement for procedures billed under unlisted CPT codes. Removing this restriction would expand access to innovative and emerging surgical procedures while better aligning payment policies across outpatient settings.
Reduce Unnecessary Quality Reporting Burdens
ASCA supported removing measures from the ASC Quality Reporting Program that do not directly improve patient outcomes and urged CMS to provide relief for facilities struggling to meet the mandated survey response thresholds for the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems Survey measure. The association also requested that CMS delay implementation of the ASC-21 patient-reported outcomes measure, recommending that the agency first evaluate the measure’s effectiveness in the inpatient setting before requiring its implementation in ASCs.
Read ASCA’s full comment letter.
*The information in this section was added by Cath Lab Digest and is not original to the ASCA press release.
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