On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) rolled out its proposed payment rule for 2026, and it included some big news for Ambulatory Surgical Centers (ASCs)! One of the standout changes? CMS is proposing to add 276 new procedures to the ASC Covered Procedures List (CPL) and remove 271 procedures from the Inpatient-Only (IPO) list, signaling a continued shift of care from hospitals to outpatient settings.
The proposed CPL additions include cardiovascular and spine procedures such as cardiac catheter ablations, percutaneous coronary interventions, vascular embolization, and posterior lumbar interbody fusion. Meanwhile, the IPO removals include a wide range of musculoskeletal, orthopedic, and urologic procedures, many of which are prime candidates for safe, efficient delivery in the ASC setting.
For ASCs, this is a huge opportunity. These additions could allow centers to offer a wider range of procedures—some of which were previously only done in hospitals. It’s a big step toward expanding the role of ASCs in delivering high-quality, cost-effective outpatient care.
In this blog, we’ll break down what this means for your center and how you can start preparing for the changes ahead.
Strategic Implications for ASCs
So, what does all this really mean for ASC leaders? Big opportunities—but also some big decisions. With more procedures on the table, now’s the time to think strategically about how your center can grow while keeping quality and safety front and center. Here are some of the key areas where leadership will need to focus to make the most of these changes.
Infrastructure Readiness
ASCs must assess physical and clinical capabilities to safely handle new procedures. The criteria revision CMS proposed removes five exclusion categories and shifts them into nonbinding physician considerations, meaning physician judgment and facility standards are more critical than ever. This includes OR configuration, PACU capacity, sterilization capabilities, and whether your existing equipment can support cardiovascular or spine procedures.
Vetting and Credentialing
Procedures formerly restricted to hospitals—especially complex or device-intensive ones—will now be up for review at the ASC level. Having clear credentialing pathways, risk assessment protocols, and patient selection guidelines in place is essential to adhering to patient safety and compliance standards. ASCs should also revisit privileging and peer review policies to ensure alignment with any new service lines and provider scopes, particularly for cardiac or interventional procedures.
Revenue and Payment Planning
With CMS estimating ASC payments rising approximately 2.4% in total for CY 2026—and additional volume from new CPL codes—facilities should evaluate coding, billing readiness, and reimbursement projections to optimize financial performance. Make sure to review your payer contracts to ensure newly added procedures are reimbursed under ASC-specific rates, and update internal fee schedules accordingly.
Shift in Site-of-Service Dynamics
As CMS phases out the IPO list (285 mostly musculoskeletal procedures in year one), many services may migrate from the inpatient or hospital outpatient setting into ASCs—creating both opportunity and competitive disruption for hospitals and ASC networks alike. ASCs can take advantage of their lower costs, streamlined workflows, and quicker recovery times to attract more referrals from payers and physicians, making a strong case as a high-quality, cost-effective alternative to hospital outpatient departments.
5 Ways to Help Your ASC Adapt
With so many changes on the horizon, it’s important to make sure your ASC is not just reacting—but getting ahead. From regulatory updates to payer relationships, a thoughtful game plan will set you up for success. Here are five practical steps to help your center prepare for the expanded procedure list and everything that comes with it:
- Stay on top of regulatory changes. Keep an eye on CMS updates as the proposed rule moves toward finalization, and double-check that your state licensing and scope-of-practice rules align with the newly added procedures.
- Get your clinical team involved early. Bring together a multidisciplinary group of physicians to evaluate which of the proposed procedures make sense for your center, and make sure you have clear safety protocols, patient selection criteria, and perioperative care workflows in place.
- Take a hard look at your operational capacity. Review your facility’s equipment, staffing, and clinical spaces to ensure they can safely and efficiently support new procedures. That includes assessing your tech stack: EMRs, scheduling systems, compliance documentation, inventory tracking, and analytics tools to ensure they can scale with the expanded services.
- Prep your coding and billing team. Make sure your revenue cycle staff is familiar with any new CPT/HCPCS codes, ASC-specific payment indicators, and documentation requirements tied to these procedures.
- Start talking to your payers. Reach out to commercial insurers and Medicare Advantage plans to update them on your expanded capabilities, and work to ensure these new procedures are covered when performed in your ASC.
The proposed addition of procedures to the ASC Covered Procedures List, plus more coming off the Inpatient-Only list, is a game-changer for ASCs. For centers ready to act, this could mean more cases, more services, and greater flexibility in how and where care is delivered.
But to really take advantage of these changes, it’s not just about adding procedures—you’ll need to make sure your facility, clinical processes, and technology providers are all ready to support them. That means evaluating your space, staffing, and workflows to ensure everything runs smoothly and safely.Now is the time for ASCs to move quickly and plan smart. If there’s anything the Surglogs team can do to help your center position itself for sustainable growth in this new, value-driven healthcare world, please don’t hesitate to reach out to us.
