Big Changes Ahead! What CMS’s Proposed 2026 Rule Means for Surgery Centers

By Allison Stock, Chief Operations Officer, SMP

When CMS dropped its 913-page proposed rule for 2026, the headline figure-547 new procedures proposed for the ASC Covered Procedures List-felt almost too big to believe. For context, last year’s update added just 21 codes, the vast majority of them dental. This proposal represents a seismic shift not just in volume, but in philosophy. For those of us in the ambulatory surgery space, it’s one of the most consequential updates in years.

The proposed 2.4% Medicare payment increase is also welcome news. While the margin may feel modest, it reinforces CMS’s continued alignment between ASC and hospital outpatient payment systems through 2026. In a reimbursement landscape often defined by uncertainty, this kind of stability helps ASC leaders plan with greater confidence.

But what really stands out in this proposal is how CMS is reframing its approach to procedural oversight. Rather than determining blanket exclusions based on generalized risk or setting, the agency is moving decisively toward empowering clinicians to decide where care belongs. That’s a significant departure from the gatekeeping model we’ve seen in the past, and one that validates the safety, efficiency, and outcomes ASCs deliver every day.

Out of the 547 procedures proposed for the ASC list, 276 come from removing exclusionary criteria CMS previously used to keep certain procedures out of the outpatient setting. The remaining 271 are being drawn from the agency’s plan to begin phasing out the inpatient-only list, with those procedures set to become eligible in ASCs as early as 2026. If finalized, this move would allow surgery centers across the country to expand access to procedures long considered out of scope—not because of clinical concern, but because of outdated policy.

Cardiovascular and spine procedures are among the biggest winners here. Posterior lumbar interbody fusions, EP studies and ablations, and even percutaneous coronary interventions are all on the list. Many ASCs already have the infrastructure and expertise to support these specialties. What’s been missing is a reimbursement model that recognizes our capability. This proposed rule could change that.

It’s also worth noting that CMS plans to retire four ASC quality reporting measures, including the COVID-19 vaccination requirement for healthcare personnel. While we remain deeply committed to quality tracking and continuous improvement, removing overly prescriptive measures can help refocus energy on initiatives that directly improve patient care. Quality work should be meaningful, not just regulatory.

At Surgical Management Professionals, we see this proposed rule as a moment of alignment between what we know works in practice and what policymakers are finally recognizing in regulation. These changes have the potential to unlock new growth opportunities, expand access to patients, and enable our partner centers to continue delivering high-quality care in the most efficient setting possible.

Stakeholder comments are due by September 15. We’re preparing our response, and we encourage every ASC leader to do the same. The decisions CMS makes this fall will shape the future of ambulatory surgery for years to come.

Let’s make sure our voice, and the voice of our patients, is heard.