Ambulatory Surgical Centers (ASCs) are on the cusp of major change in 2026. With sweeping CMS proposals, expanding procedure lists, and tighter regulatory scrutiny, the financial stakes for ASCs and the practices that rely on them, could not be higher. If you don’t adapt now, you risk losing revenue and falling behind on the compliance curve.
At Konnext Solutions, we understand these high-stakes shifts. We’ve helped dozens of practices and ASCs get ahead of policy changes, optimize billing workflows, and protect their bottom lines.
What’s New for ASCs in 2026, Key Policy Updates You Can’t Ignore
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2.4% ASC Payment Rate Increase (If You Meet Quality Standards)
- CMS proposes a 2.4% increase in payment rates for ASCs that satisfy quality reporting requirements. Centers for Medicare & Medicaid Services+2Norton Rose Fulbright+2
- The payment bump is based on a 3.2% hospital market basket update, reduced by a 0.8% productivity adjustment. Centers for Medicare & Medicaid Services+1
- This extension of the hospital-market-basket method (previously tested) underscores CMS’ intent to continue incentivizing outpatient surgical care. chamberhillstrategies.com
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Massive Expansion of the ASC Covered Procedures List (CPL)
- CMS proposes to add 276 new procedures to the ASC Covered Procedures List. ASC Association+1
- Additionally, 271 codes are proposed to move from the Medicare Inpatient-Only (IPO) list into the ASC CPL for 2026. ASC News+1
- This change would significantly broaden which surgeries can be shifted from inpatient hospital settings to ASCs, potentially lowering costs for payers and increasing opportunity for ASCs. ASC News
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Inpatient-Only (IPO) List Phase-Out
- CMS is proposing a three-year phase-out of its Inpatient-Only (IPO) list, starting in 2026. Centers for Medicare & Medicaid Services+2American Urological Association+2
- For 2026 specifically, many musculoskeletal procedures typically restricted to inpatient settings would be eligible for ASC performance. ASC News
- This shift signals a continued push to perform more procedures in outpatient settings, where care can be less expensive and more efficient. ASC Association+1
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ASC Quality Reporting (ASCQR) Changes
- CMS proposes updates to its ASC Quality Reporting program, including new patient-reported outcome measures around recovery information. Centers for Medicare & Medicaid Services+1
- Some previously required measures, such as COVID-19 vaccination and health equity screening, may be removed, reducing administrative burden.
- ASCs failing to comply with reporting requirements could face penalties; so quality-reporting strategy must be part of your financial planning.
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Medicare Prior Authorization Expands to ASCs
- Starting December 15, 2025, Medicare is launching a 5-year demonstration, expanding prior authorization requirements for certain ASC procedures. Kiplinger
- The demonstration covers 10 states (including Texas), and certain procedures will require pre-authorization, even if documentation standards do not change. Kiplinger
- This increases the risk of denials or delayed payments, and makes prior-authorization workflows more critical than ever.
Why These Changes Are Risky for Practices, Without a Partner
- Cash flow disruption: Expanded procedure list + quality requirements = more complex billing, more potential for denials.
- Compliance burden: New quality reporting demands + prior auth = more documentation, more complexity.
- Coding challenges: With many new codes going onto the ASC list, billing teams may struggle to keep up.
- Site-of-service risk: Misclassifying where a procedure was performed (ASC vs hospital) could lead to underpayment or rejection.
How Konnext Solutions Helps You Protect Revenue in 2026
Here’s how our team supports ASCs and surgical practices through these changes:
- Regulatory Monitoring: We follow CMS rule-making closely and proactively update our billing strategy to align with proposed and final rules.
- Procedure List Optimization: We map newly eligible ASC procedures to your practice’s case mix, helping you maximize ASC adoption.
- Billing Workflow Overhaul: We ensure your billing team uses the right place-of-service codes, sequences procedures correctly, and applies required modifiers.
- Prior Auth Support: We build pre-authorization workflows and track requests to reduce denials tied to the new Medicare demonstration.
- Quality Reporting Compliance: Our RCM experts help prepare quarterly reporting, so you meet ASCQR requirements and avoid payment penalties.
- Training & Audit Prep: We provide targeted training on 2026 ASC coding and run mock audits to prevent payment delays and flag risk before it costs you.
What You Should Do Now to Prepare
- Conduct a 2026 ASC Readiness Assessment
Analyze your case mix, payer contracts, and procedural volume to understand the impact of the new ASC-CPL. - Update Billing & Coding Systems
Ensure your EHR / PMS supports new procedure codes and aligns with ASC payment policy changes. - Train Your Staff
Educate your billing, clinical, and administrative teams on anticipated changes: prior auth, documentation, place-of-service. - Build a Prior Authorization Pipeline
Start managing pre-auth requests nowdon’t wait for denials. - Partner with an RCM Expert
Working with Konnext Solutions ensures you’re ready for 2026’s policy shift without exposing your practice to unnecessary financial risk.
