2026 OPPS/ASC proposed rule

🧭 1. What’s Changing?

In its Calendar Year 2026 OPPS/ASC proposed rule, CMS proposes a three-year phase-out of the IPO list—starting by removing 285 primarily musculoskeletal procedures in 2026. Historically, this list mandated that certain surgeries could only be billed under Medicare Part A and required hospital inpatient stays. CMS argues that many procedures on the list are now safely performed outpatient, thanks to advances in clinical practice and recovery protocols

🏥 2. Why It Matters for ASCs

a. ASC Covered Procedures List (CPL) Expansion

CMS is proposing to:

• Revise ASC CPL criteria, reducing restrictions and empowering physician judgment.

• Add 276 new procedures, plus 271 procedures transitioned off the IPO list, giving ASCs access to 547 additional codes for 2026

This means ASCs could offer more services currently limited to hospitals—potentially increasing surgical volumes and revenue.

b. Payment Implications

• ASCs generally receive 20% coinsurance under Medicare Part B—often a lower overall cost than a hospital Part A stay. Patients will see lower costs.

• CMS plans to continue applying the hospital market basket update to ASC payments through 2026

This creates an incentive for shifting procedures from hospitals to ASCs, with both lower patient costs and predictable facility payments.

c. Medical Review Safeguards

Quality measures are in place and incident reporting and tracking will need to be done to ensure patient safety, however many of these procedures are already being done in outpatient and office based settings will no impact to the overall safety profile.

🏢 3. Impacts on Office-Based Surgery

Although the proposed changes focus on hospitals and ASCs, implications for office-based settings exist:

• Site-neutral payment expansion hints CMS might aim to address disparities in payments between hospital outpatient departments, ASCs, and physician offices

• Procedures transitioning off the IPO list could eventually be performed and billed in office-based settings, pending additional policy guidelines.

• Transitioning site-neutral or lower-cost procedures to physician offices could improve convenience and lower costs—but may require new coding, credentialing, and compliance practices.

🛡4. Concerns & Stakeholder Feedback

a. Hospital Perspective

The American Hospital Association voiced concern that eliminating the IPO list and pushing site-neutral payment risks overlooking complexity and safety issues, especially since hospital patients tend to be sicker or rural

b. ASC / Provider Response

ASC leaders argue the expansion empowers physician judgment, increases access, and shifts care toward lower-cost, patient-friendly settings

📊 5. Net Effect Summary

Impact Area Expected Result

Surgical Access Broader array of outpatient options

Patient Costs Likely reduction due to Part B vs Part A

ASC Growth Strong volume increase, particularly for musculoskeletal and spine procedures

Office-Based Care Potential future billing expansion pending additional guidance

Hospitals’ Inpatient Volume Will decline for select procedures

Safety & Oversight Maintained via physician standards and quality measures

🔮 6. What’s Next?

• The rule opens for public comment until mid-September 2025

• Finalization could occur late 2025, with provisions taking effect January 1, 2026.

• Stakeholder input may influence which procedures shift control or require additional site-based safeguards.

✅ Final Takeaway

The elimination of the IPO list marks a major shift toward outpatient-first surgical care. ASCs are poised to benefit significantly—gaining new procedure codes and lower-cost competitive advantages, while office-based settings may also see expanded roles in the future.