CMS Expands ASC Procedure List by 560 Codes
The Centers for Medicare & Medicaid Services has expanded the Ambulatory Surgery Center (ASC) procedure list by 560 codes. According to an analysis by SCA Health, this move significantly increases opportunities for advanced imaging and interventional procedures to be performed in lower-cost outpatient settings. The expansion is a key regulatory driver accelerating the migration of services from traditional hospital outpatient departments to ASCs and specialty clinics.
- The primary driver for shifting procedures to ASCs is cost savings; Medicare pays ASCs approximately 55% of the rate paid to hospital outpatient departments (HOPDs) for the same service. For example, Medicare pays $964 for a cataract surgery in an ASC versus $1,671 in a hospital setting. - This expansion is part of a larger CMS initiative to phase out the "Inpatient-Only" (IPO) list over three years. This list historically designated procedures that Medicare would only reimburse in a hospital inpatient setting; its elimination gives physicians more discretion to move appropriate cases to an outpatient facility. - Of the 560 newly added codes, 271 are procedures being removed from the IPO list, while 289 were previously only payable in the hospital outpatient setting. Key specialties impacted include cardiovascular services, such as percutaneous coronary intervention (PCI) and electrophysiology studies, along with spinal procedures like posterior lumbar interbody fusion. - Projections show surgical procedure volume in ASCs is expected to grow by at least 25% over the next decade, with the total market revenue forecasted to increase from $45 billion in 2024 to $57 billion by 2030. - While the rule change expands potential case volume, some ASC leaders are concerned that commercial payers may leverage the new Medicare approvals to justify lowering their own reimbursement rates for these procedures, using the ASC payment level as a new baseline. - The migration of
