ASC Pay in 2027: CMS Proposes a 2.4% Raise

CMS proposes a 2.4% payment increase for ambulatory surgery centers in calendar year 2027, down from the 2.6% finalized for 2026, according to the agency's July 2, 2026 fact sheet on proposed rule CMS-1850-P. The raise applies to about 6,400 ASCs that meet quality reporting requirements, and CMS expects a final rule in November 2026.

The proposal pairs that smaller raise with a larger procedure list. CMS would add 618 codes to the ASC covered procedures list, according to ECG Management Consultants' summary of the rule. A practice that owns part of an ASC should read both numbers together.

What makes up the 2.4% update

The 2.4% figure starts with a projected hospital market basket increase of 3.2%. CMS then subtracts a productivity adjustment of 0.8 percentage points. The 2026 update used a 3.3% market basket and a 0.7-point productivity cut, which left 2.6%, according to CMS's final rule fact sheet for 2026.

The conversion factor is the dollar amount Medicare multiplies by each procedure's relative weight. The Association of Interventional Pain Physicians (ASIPP) lists the 2026 ASC conversion factor at $56.322 and the proposed 2027 factor at $57.766. That is a 2.6% gap, slightly above the 2.4% update. ASIPP does not explain the difference and advises checking the final rule.

Item	CY2026 final rule	CY2027 proposed rule
ASC payment update	2.6%	2.4%
Hospital market basket increase	3.3%	3.2%
Productivity adjustment	0.7 point	0.8 point
ASCs covered	About 6,000	About 6,400
ASC conversion factor	$56.322	$57.766
Inpatient only list removals	285 services	638 services

Sources: CMS fact sheets on the CY2026 final rule and the CY2027 proposed rule (CMS-1850-P). The conversion factors come from ASIPP.

CMS also states the cost of skipping quality reporting. ASCs that fail to submit required data receive a 2-percentage point cut to their annual update, according to CMS. Under the 2027 proposal that turns a 2.4% raise into 0.4%, as ASIPP notes.

Which procedures gain and which lose

A single update percentage hides large differences by code. ASIPP reviewed the proposed 2027 rates against 2026 rates for common interventional pain and spine procedures. The nervous system and musculoskeletal specialty groups each rise 6% on average in its review. Individual codes move much more in both directions.

CPT code	Procedure	Proposed change vs 2026
63685	Spinal cord stimulator generator insertion or replacement	+14.8%
64555	Peripheral nerve stimulator electrode implant	+9.8%
27279	Minimally invasive sacroiliac joint fusion	+7.1%
64628	Basivertebral nerve ablation	+6.5%
62323	Interlaminar epidural injection, lumbar or sacral	-3.8%
64635	Lumbar facet radiofrequency ablation, single joint	-4.3%

Source: Association of Interventional Pain Physicians (ASIPP), CY 2027 Medicare ASC proposed rule analysis. ASIPP does not give dollar amounts per code. Those sit in Addenda AA and BB on the CMS website.

An ASC that bills mostly injections and a center that bills mostly implants will see opposite results from the same rule. A center built around lumbar epidurals sees 3.8% less per case while the headline says 2.4% more.

The procedure list keeps growing

The 2026 rule added 289 procedures to the ASC covered procedures list under revised criteria. CMS also moved 271 codes off the inpatient only list and onto the ASC list, according to its 2026 fact sheet. The 2027 proposal adds 618 codes, according to ECG Management Consultants and ASIPP.

The inpatient only list shrinks in step. CMS calls 2027 the second year of a three-year phase-out and proposes to remove 638 services, up from 285 in 2026. The 2027 removals include procedures in the digestive, urinary, respiratory, male genital and female genital clinical families.

CMS estimates total ASC payments will rise by about $520 million compared with estimated CY2026 payments, according to ECG. A longer list does not guarantee a payer will cover each code at the ASC site of service. Medicare listing a code and a commercial payer contract listing it are separate events, so billing staff should check each new code against current contracts before the owners commit equipment money.

Other proposals that reach practices

CMS proposes prior authorization for eight more botulinum toxin injection codes for dates of service on or after July 1, 2027. CMS cites volume increases it could not explain. ASIPP reports the requirement applies in hospital outpatient departments.

The quality programs would drop the colonoscopy follow-up interval measure, Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients. Removal starts with the CY2027 reporting period and the CY2029 payment determination. CMS also asks for comment on stratifying the all-cause transfer and admission measure by phase of care.

For off-campus hospital departments, CMS would extend its volume control method to imaging without contrast and pay the physician fee schedule equivalent rate. CMS estimates about $260 million in first-year Part B reductions from that change. Rural sole community hospitals are exempt.

What administrators can check now

The comment period closed on August 31, 2026, so the next change is the final rule. ASIPP expects the 2027 final rule in November 2026. Two checks fit the time before it arrives.

Pull the ASC's top 20 CPT codes by volume and compare each against the addenda tables. Mix matters more than the 2.4% average.
Confirm the ASC submitted all quality data. The 2-point penalty costs more than four-fifths of the raise.

Commercial contracts priced as a percentage of the Medicare ASC rate will move with the final tables, so list them now. The proposal also changes the Medicare hospital outpatient rates that ASCs often use as a comparison in facility fee talks. CMS projects a 2.4% update for about 3,500 hospitals in the same rule, matching the ASC figure.

Sources

Talk to us

Fifteen minutes about your practice and the systems you run.

Book a demo