Bleak Present. Bright Future?

CMS’ changes for ASCs in 2025 are dismal, but there is optimism political change will make for a brighter 2026.

While the U.S. Centers for Medicare & Medicaid Services did add 21 non-earth-shattering medical and dental procedures to its ASC Covered Procedures List, none of them were the 18 spine and heart codes that industry advocates considered the big-ticket items they wanted this year. That’s strike one.

Additional quality reporting requirements proposed in CMS’ Proposed Rule that was released in July remained in the Final Rule, which was issued in November and went into effect on Jan. 1, despite significant opposition saying that compliance with the new quality reporting rules would be overly cumbersome — if not impossible. Strike two.

The proposal also includes an effective 2.9% increase in facility reimbursements for procedures that are already covered in ASCs and HOPDs, a 0.3% increase from what was originally proposed. ASC leaders are unhappy with this because getting the same amount of an increase as HOPDs doesn’t narrow the existing delta between ASCs and HOPDs, the latter of which get more money for identical procedures. The hospital industry also opposed the identical increase, but for different reasons, saying HOPDs need higher increases overall to provide essential and adequate care throughout their health systems.

For ASCs, that’s strike three, according to David Shapiro, MD, CASC, an anesthesiologist who practices in Florida and is a board member of the ASC Quality Collaboration, a nonprofit advocacy group.

“CMS really struck out by whiffing on the three big issues our industry wanted them to address: reimbursement; quality reporting; and the ASC-approved procedure list, which is very disappointing,” he says. “Advocacy groups write incredibly detailed, multipage comment letters to CMS each year on behalf of the ASC community after the release of the Proposed Rule,

which was historically unfavorable to ASCs this year. They didn’t address any of our concerns again this year, which is sadly what we have grown to expect.”

The new CPT codes can be found in Table 154 of the final rule.

Changes likely in 2026

Procedures that have wound up on or off the ASC Covered Procedures List have varied widely in recent years, depending on the administration in the White House and which party has majorities in the House and Senate.

The first Trump administration announced plans in 2020 to eliminate the inpatient-only list entirely by 2024 and added 266 procedures to the ASC-approved list in 2021. Many of those procedures were removed by the Biden administration in 2022.

While the second Trump administration that took over this year doesn’t technically get a bite at the apple to implement changes to CMS’s annual Final Rule until Jan. 1, 2026, there’s hope that those discussions will begin later this year. President Trump has nominated Robert Kennedy Jr. to be secretary of the $1.7 trillion U.S. Department of Health and Human Services (HHS), which includes CMS. President Trump appointed endocrinologist Dorothy Fink, MD, as acting HHS secretary during the nomination process for Mr. Kennedy. Mehmet Oz, MD, is President Trump’s selection for CMS administrator. He too awaits Senate confirmation.

“That’s what everyone’s holding their breath to see because even after only a couple of days in, it’s apparent there are undoubtedly some major changes that are going to be made personnel-wise at HHS, the highest health portion of the federal bureaucracy,” says Dr. Shapiro. “I would expect that there will be a lot of personnel and philosophical changes at CMS. Congress is really CMS’ boss, and you’ve got Republican majorities in all facets of government now. I think as soon as the dust settles from the transition we’re going to see some real changes in the healthcare sphere.”

That includes listening ears for ASC leaders’ wish list for additions to the 2026 ASC Covered Procedures List. “I think we’ll have a much more receptive audience, which is exciting to me as a clinician,” says Dr. Shapiro. “It would really dismantle CMS’ hold on preventing patients from receiving the care they should receive in ASCs by their severe limitation of procedures on the list. The Biden administration set up a new mechanism for physicians and others to propose adding procedures to ASCs, then completely ignored the industry’s suggestions to add spine and cardiac procedures that absolutely, unquestionably are clinically appropriate for Medicare beneficiaries to receive those procedures in ASC settings.”

The 18 codes suggested by the Ambulatory Surgery Center Association were for procedures that have been safely performed in ASCs for years on non-Medicare patients, including on patients old enough to be eligible for Medicare but who have private insurance, notes Dr. Shapiro.

“Despite what may be going on in other arenas, I’m very hopeful that this new administration will take ASCs seriously and allow us to provide the care I know we can, in addition to really addressing some of the issues that have arisen with the onerous quality reporting program and the widening reimbursement disparity between ASC payments and HOPD payments for clinically equivalent services.”

Other 2025 specifics

Under the Final Rule, centers must still report COVID-19 vaccination coverage data for its staff under CMS’ ASC Quality Reporting (ASCQR) Program, even though CMS announced in 2024 that it would no longer mandate COVID-19 vaccinations for healthcare personnel.

Three additional reporting measures were also adopted under the ASCQR: the Facility Commitment to Health Equity; the Screening for Social Drivers of Health; and the Screen Positive Rate for Social Drivers of Health. Failure to submit and publicly display data collected could result in ASCs being assessed a two-percentage-point payment penalty to their annual payment rate updates, CMS says. The agency says the additional reporting is to ensure patient safety and reduce hospital admissions.

Dr. Shapiro says ASCs don’t have the ability to collect such data from their patients or, as providers of elective surgeries that take only a few hours, make an impact on the patients based on the data. It’s also an unfunded mandate that facilities can’t afford, he adds.

In better news, the rule approves payments for the following medications and one device: Exparel, a long-acting local anesthetic; Omidria, a drug used during cataract surgery; the ocular insert Dextenza; Xaracoll, an implant used in inguinal hernia repairs; Zynrelef, a mix of bupivacaine and meloxicam; Ketorolac tromethamine injection, a non-steroidal anti-inflammatory; and the ON-Q pump, a device that delivers local anesthetics directly to the surgical site. OSM